Provider Demographics
NPI:1831462340
Name:BEAN, DENNIS LEE
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEE
Last Name:BEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S 129TH ST
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-9210
Mailing Address - Country:US
Mailing Address - Phone:913-543-5001
Mailing Address - Fax:913-543-5007
Practice Address - Street 1:550 S 129TH ST
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-9210
Practice Address - Country:US
Practice Address - Phone:913-543-5001
Practice Address - Fax:913-543-5007
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist