Provider Demographics
NPI:1972192375
Name:FORBES, BENNIE LLOYD III (CPHT)
Entity Type:Individual
Prefix:MR
First Name:BENNIE
Middle Name:LLOYD
Last Name:FORBES
Suffix:III
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 JONES BUTLER RD # 86B
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-6437
Mailing Address - Country:US
Mailing Address - Phone:281-794-0506
Mailing Address - Fax:
Practice Address - Street 1:949 WILLIAM D FITCH PKWY
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4638
Practice Address - Country:US
Practice Address - Phone:979-690-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279043183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician