Provider Demographics
NPI:1700180676
Name:BENTON, RICHARD BRYANT (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRYANT
Last Name:BENTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7657 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2054
Mailing Address - Country:US
Mailing Address - Phone:901-383-8733
Mailing Address - Fax:901-383-8736
Practice Address - Street 1:7657 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2054
Practice Address - Country:US
Practice Address - Phone:901-383-8733
Practice Address - Fax:901-383-8736
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33575183500000X
MSE-010505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist