Provider Demographics
NPI:1821324534
Name:BRISTER, BEN J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:J
Last Name:BRISTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 US HIGHWAY 79 S
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-4406
Mailing Address - Country:US
Mailing Address - Phone:903-655-7561
Mailing Address - Fax:903-657-7973
Practice Address - Street 1:2126 US HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-4406
Practice Address - Country:US
Practice Address - Phone:903-655-7561
Practice Address - Fax:903-657-7973
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist