=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356335566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNETT HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2005
-----------------------------------------------------
Last Update Date | 08/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 367 DAVE CREEK PKWY
-----------------------------------------------------
City | FAIRFIELD BAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72088-3631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-884-3388
-----------------------------------------------------
Fax | 501-884-3301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1223
-----------------------------------------------------
City | FAIRFIELD BAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72088-1223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-884-3388
-----------------------------------------------------
Fax | 501-884-3301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, PHARMACIST
-----------------------------------------------------
Name | DR. JENNY BOONE TREECE
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 501-884-3388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | AR20041
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | AR20041
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------