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General NPI Number Information
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NPI Number | 1346427242
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Entity Type | Organization
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Legal Business Name | BENTON DISCOUNT PHARMACY (EPSDT)
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 2606 MAIN ST
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City | BENTON
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State | KY
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Zip | 42025-1819
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Country | US
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Telephone | 270-527-1409
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Fax | 270-527-2801
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Provider Business Mailing Address
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Address Line | 2606 MAIN ST
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City | BENTON
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State | KY
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Zip | 42025-1819
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Country | US
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Telephone | 270-527-1409
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Fax | 270-527-2801
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Authorized Official
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Title or Position | PHARMACIST/PHARMACY MGR
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Name | MORGAN BECK
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Credential | RPH
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Telephone | 270-527-1409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | P01049
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License Number State | KY
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