Healthcare Provider Details

I. General information

NPI: 1649661257
Provider Name (Legal Business Name): ROBERT BENNETT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 N MAIN ST
LAS CRUCES NM
88001-1174
US

IV. Provider business mailing address

940 N MAIN ST
LAS CRUCES NM
88001-1174
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-5900
  • Fax: 575-524-2667
Mailing address:
  • Phone: 575-524-5900
  • Fax: 575-524-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00004138
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: