MEDICARE: MR. ROBERT BENNETT 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	RP00004138	NM

General Provider Information

NPI Number	:	1649661257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT BENNETT RPH

Provider Business Mailing Address
First Line	:	940 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1174
Country	:	US
Telephone Number	:	575-524-5900
Fax Number	:	575-524-2667

Provider Business Practice Location Address
First Line	:	940 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1174
Country	:	US
Telephone Number	:	575-524-5900
Fax Number	:	575-524-2667

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

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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