Provider Demographics
NPI:1992399372
Name:BENNETT, STEPHEN DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DEAN
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:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-0029
Mailing Address - Country:US
Mailing Address - Phone:254-205-2253
Mailing Address - Fax:254-694-6495
Practice Address - Street 1:203 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2302
Practice Address - Country:US
Practice Address - Phone:254-694-2249
Practice Address - Fax:254-694-6495
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist