Provider Demographics
NPI:1528317807
Name:BENGSTON, THERESA WORDEN (RPH)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:WORDEN
Last Name:BENGSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 REIDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3654
Mailing Address - Country:US
Mailing Address - Phone:864-576-0401
Mailing Address - Fax:864-576-1823
Practice Address - Street 1:2401 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3654
Practice Address - Country:US
Practice Address - Phone:864-576-0401
Practice Address - Fax:864-576-1823
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist