Provider Demographics
NPI:1548651888
Name:BENDIXEN, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BENDIXEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1496
Mailing Address - Street 2:
Mailing Address - City:ONSET
Mailing Address - State:MA
Mailing Address - Zip Code:02558-1496
Mailing Address - Country:US
Mailing Address - Phone:508-273-7465
Mailing Address - Fax:
Practice Address - Street 1:479 STATE RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-4309
Practice Address - Country:US
Practice Address - Phone:508-979-7531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT9651183700000X
MA600107010209432183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician