Provider Demographics
NPI:1184637423
Name:DENTON, J. R (RPH)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:R
Last Name:DENTON
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 1:111 CASSIES TRL
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-7700
Mailing Address - Country:US
Mailing Address - Phone:662-628-5331
Mailing Address - Fax:662-628-8444
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:PUBLIC SQUARE
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916
Practice Address - Country:US
Practice Address - Phone:662-628-5331
Practice Address - Fax:662-628-8444
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-05888183500000X
TN11530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11530OtherPHARMACY LICENSE
MSE-O5888OtherPHARMACY LICENSE