Provider Demographics
NPI:1689959728
Name:BENNETT, CARL J (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8571 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5218
Mailing Address - Country:US
Mailing Address - Phone:314-962-5545
Mailing Address - Fax:314-968-1704
Practice Address - Street 1:8571 WATSON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-5218
Practice Address - Country:US
Practice Address - Phone:314-962-5545
Practice Address - Fax:314-968-1704
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO41709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist