MEDICARE: GARY BENTON INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	AR20238	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1994535	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275674905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY BENTON INC

Provider Business Mailing Address
First Line	:	811 MARSHALL RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3744
Country	:	US
Telephone Number	:	501-982-3551
Fax Number	:	501-982-2010

Provider Business Practice Location Address
First Line	:	811 MARSHALL RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3744
Country	:	US
Telephone Number	:	501-982-3551
Fax Number	:	501-982-2010

Authorized Official
Title or Position	:	OWNER
Name	:	GARY BENTON
Credential	:
Telephone Number	:	501-982-3551

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	04/13/2017

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Directions to “GARY BENTON INC ” Practice Location

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