Provider Demographics
NPI:1598103756
Name:BENNIN, BETH MARIE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MARIE
Last Name:BENNIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E MAES AVE
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-1527
Mailing Address - Country:US
Mailing Address - Phone:920-788-9154
Mailing Address - Fax:
Practice Address - Street 1:800 E MAES AVE
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-1527
Practice Address - Country:US
Practice Address - Phone:920-788-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15054-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist