Healthcare Provider Details

I. General information

NPI: 1952295883
Provider Name (Legal Business Name): RONALD E BENNETT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 VIRGINIA AVE
COLLINSVILLE VA
24078-2244
US

IV. Provider business mailing address

1520 EGGLESTON FALLS RD
RIDGEWAY VA
24148-4466
US

V. Phone/Fax

Practice location:
  • Phone: 276-647-3886
  • Fax:
Mailing address:
  • Phone: 276-340-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202010021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: