Provider Demographics
NPI:1841333903
Name:BENNETT, KEVIN STEWART (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:STEWART
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 1:2738 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-6817
Mailing Address - Country:US
Mailing Address - Phone:812-867-0166
Mailing Address - Fax:
Practice Address - Street 1:12500 HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7031
Practice Address - Country:US
Practice Address - Phone:812-867-8611
Practice Address - Fax:812-867-8616
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018212A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist