Provider Demographics
NPI:1457644320
Name:BENTLEY, CHRISTIAN SANDERS (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:SANDERS
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:SANDERS
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:727 ALBRITTON RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-4601
Mailing Address - Country:US
Mailing Address - Phone:334-488-4761
Mailing Address - Fax:334-222-0797
Practice Address - Street 1:1017 RIVER FALLS STREET
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420
Practice Address - Country:US
Practice Address - Phone:334-222-9414
Practice Address - Fax:334-222-0797
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15351183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6480874OtherDRIVERS LICENSE NUMBER