Provider Demographics
NPI:1841747649
Name:BENNETT, RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LANCASTER DR NE
Mailing Address - Street 2:KAISER PERMANETE NORTH LANCASTER PHARMACY
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1221
Mailing Address - Country:US
Mailing Address - Phone:503-763-5978
Mailing Address - Fax:503-375-5730
Practice Address - Street 1:425 BURLWOOD AVE N
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-2252
Practice Address - Country:US
Practice Address - Phone:503-930-5726
Practice Address - Fax:503-375-5730
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00059391835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist