MEDICARE: BENTLEY PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336C0003X	Community/Retail Pharmacy		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164592978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENTLEY PHARMACY

Provider Business Mailing Address
First Line	:	201 W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-3115
Country	:	US
Telephone Number	:	972-563-3311
Fax Number	:	972-563-5808

Provider Business Practice Location Address
First Line	:	201 W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-3115
Country	:	US
Telephone Number	:	972-563-3311
Fax Number	:	972-563-5808

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRED BENTLEY
Credential	:
Telephone Number	:	972-563-3311

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	12/01/2009

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Directions to “BENTLEY PHARMACY ” Practice Location

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