Provider Demographics
NPI:1194016725
Name:BENTON, JOSHUA CHRISTOPHER (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:CHRISTOPHER
Last Name:BENTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 STATE ROUTE 151
Mailing Address - Street 2:
Mailing Address - City:MINGO JCT
Mailing Address - State:OH
Mailing Address - Zip Code:43938-7931
Mailing Address - Country:US
Mailing Address - Phone:304-723-6331
Mailing Address - Fax:304-723-1131
Practice Address - Street 1:651 COLLIERS WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5053
Practice Address - Country:US
Practice Address - Phone:304-723-6331
Practice Address - Fax:304-723-1131
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0007156OtherPHARMACY LICENSE