Provider Demographics
NPI:1548543093
Name:BENTZ, CHELSIE RAE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHELSIE
Middle Name:RAE
Last Name:BENTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 W COUNTY ROAD 500 S
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-6863
Mailing Address - Country:US
Mailing Address - Phone:812-352-1326
Mailing Address - Fax:
Practice Address - Street 1:2260 W COUNTY ROAD 500 S
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-6863
Practice Address - Country:US
Practice Address - Phone:812-352-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023246A183500000X
KY014605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist