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NPI Code Detail

MEDICARE: RAE LYNN BENTON RPH

MEDICARE: RAE LYNN BENTON 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
1183500000XPharmacistRPH014641GA

General Provider Information

NPI Number : 1841282472
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAE LYNN BENTON RPH
Provider Business Mailing Address
First Line : 120 RIVERCREST LN
Second Line :
City : SUWANEE
State : GA
Zip : 30024-5439
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1200 NORTHSIDE FORSYTH DR
Second Line : NORTHSIDE HOSPITAL FORSYTH PHARMACY
City : CUMMING
State : GA
Zip : 30041-7659
Country : US
Telephone Number : 770-844-3291
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 07/08/2007

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Directions to “ RAE LYNN BENTON RPH” Practice Location

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