Provider Demographics
NPI:1356335566
Name:BENNETT HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:BENNETT HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:BOONE
Authorized Official - Last Name:TREECE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-884-3388
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72088-1223
Mailing Address - Country:US
Mailing Address - Phone:501-884-3388
Mailing Address - Fax:501-884-3301
Practice Address - Street 1:367 DAVE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD BAY
Practice Address - State:AR
Practice Address - Zip Code:72088-3631
Practice Address - Country:US
Practice Address - Phone:501-884-3388
Practice Address - Fax:501-884-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ARAR200413336L0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132833407Medicaid
AR0416633OtherNCPDP
AR142981716Medicaid
ARAR20041OtherPHARMACY PERMIT
AR3977470001Medicare NSC
ARAR20041OtherPHARMACY PERMIT