Provider Demographics
NPI:1013093814
Name:BENTLEY, DEBORAH KAY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:KAY
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:GAMALIEL
Mailing Address - State:KY
Mailing Address - Zip Code:42140-8973
Mailing Address - Country:US
Mailing Address - Phone:270-457-3310
Mailing Address - Fax:
Practice Address - Street 1:529 CAPP HARLAN RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1808
Practice Address - Country:US
Practice Address - Phone:270-487-9231
Practice Address - Fax:270-487-6800
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8942183500000X
TN5895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist