MEDICARE: J. R. DENTON RPH.

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	183500000X	Pharmacist	E-05888	MS
2	183500000X	Pharmacist	11530	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11530	OTHER	TN	PHARMACY LICENSE
2	E-O5888	OTHER	MS	PHARMACY LICENSE

General Provider Information

NPI Number	:	1184637423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J. R. DENTON RPH.

Provider Business Mailing Address
First Line	:	111 CASSIES TRL
Second Line	:
City	:	CALHOUN CITY
State	:	MS
Zip	:	38916-7700
Country	:	US
Telephone Number	:	662-628-5331
Fax Number	:	662-628-8444

Provider Business Practice Location Address
First Line	:	131 MAIN ST
Second Line	:	PUBLIC SQUARE
City	:	CALHOUN CITY
State	:	MS
Zip	:	38916
Country	:	US
Telephone Number	:	662-628-5331
Fax Number	:	662-628-8444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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