=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952295883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD E BENNETT RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 VIRGINIA AVE
-----------------------------------------------------
City | COLLINSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24078-2244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-647-3886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1520 EGGLESTON FALLS RD
-----------------------------------------------------
City | RIDGEWAY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24148-4466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-340-2219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202010021
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------