Provider Demographics
NPI:1356840912
Name:BENJAMIN, BETH WASLEY (RPH)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:WASLEY
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-2845
Mailing Address - Country:US
Mailing Address - Phone:865-429-6009
Mailing Address - Fax:865-429-5392
Practice Address - Street 1:1414 PARKWAY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-2845
Practice Address - Country:US
Practice Address - Phone:865-429-6009
Practice Address - Fax:865-429-5392
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist