Individual
ANTHONY WILLEM VAN DE VENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2650 S WALNUT ST, BLOOMINGTON, IN 47401-7302
(812) 336-6223
Mailing address
2650 S WALNUT ST, BLOOMINGTON, IN 47401-7302
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26021078A
IN
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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