Provider Demographics
NPI:1770188229
Name:BENCH, CALLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:BENCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 NORTHLAKE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-9569
Mailing Address - Country:US
Mailing Address - Phone:501-658-2515
Mailing Address - Fax:
Practice Address - Street 1:13907 HIGH RD
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103-3212
Practice Address - Country:US
Practice Address - Phone:501-451-7715
Practice Address - Fax:501-451-7761
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty