Provider Demographics
NPI:1417384413
Name:BENTON, JOAL TIMOTHY (RPH)
Entity Type:Individual
Prefix:
First Name:JOAL
Middle Name:TIMOTHY
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 1:1125 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3647
Mailing Address - Country:US
Mailing Address - Phone:501-327-9746
Mailing Address - Fax:501-327-2084
Practice Address - Street 1:1125 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3647
Practice Address - Country:US
Practice Address - Phone:501-327-9746
Practice Address - Fax:501-327-2084
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist