Provider Demographics
NPI:1568760619
Name:DENTON, ELMER LOWELL
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:LOWELL
Last Name:DENTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 BENVENUE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6344
Mailing Address - Country:US
Mailing Address - Phone:252-977-2616
Mailing Address - Fax:252-977-0008
Practice Address - Street 1:1630 BENVENUE RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6344
Practice Address - Country:US
Practice Address - Phone:252-977-2616
Practice Address - Fax:252-977-0008
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist