=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215043930
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJIE LANE COX D.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 906 TUSCULUM BLVD
-----------------------------------------------------
City | GREENEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37745-4004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-638-7101
-----------------------------------------------------
Fax | 423-638-9105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74 DAHLIA ST W
-----------------------------------------------------
City | MOSHEIM
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37818-3673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-422-7915
-----------------------------------------------------
Fax | 423-638-9105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5588
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------