Provider Demographics
NPI:1053686444
Name:BENTON, CHARLES BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BRUCE
Last Name:BENTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34923 VESSEL CV
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-2748
Mailing Address - Country:US
Mailing Address - Phone:302-645-8202
Mailing Address - Fax:
Practice Address - Street 1:26191 JOHN WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-945-6064
Practice Address - Fax:302-945-5999
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0001828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist