Provider Demographics
NPI:1639283625
Name:BEN JAY CARNES
Entity Type:Organization
Organization Name:BEN JAY CARNES
Other - Org Name:RIPPETOE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/ HEAD TECH
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-752-6133
Mailing Address - Street 1:205 E HALL ST
Mailing Address - Street 2:
Mailing Address - City:BANGS
Mailing Address - State:TX
Mailing Address - Zip Code:76823-3495
Mailing Address - Country:US
Mailing Address - Phone:325-752-6133
Mailing Address - Fax:325-752-6412
Practice Address - Street 1:205 E HALL ST
Practice Address - Street 2:
Practice Address - City:BANGS
Practice Address - State:TX
Practice Address - Zip Code:76823-3495
Practice Address - Country:US
Practice Address - Phone:325-752-6133
Practice Address - Fax:325-752-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX33573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093511OtherPK
TX143677Medicaid
2093511OtherPK