=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114938776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENTLEY RXPRESS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 S 3RD ST
-----------------------------------------------------
City | IRONTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45638-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-533-2345
-----------------------------------------------------
Fax | 740-533-1544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 S 3RD ST
-----------------------------------------------------
City | IRONTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45638-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-533-2345
-----------------------------------------------------
Fax | 740-533-1544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DANNY BENTLEY
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 740-533-2345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 020665400
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------