Provider Demographics
NPI:1649661257
Name:BENNETT, ROBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
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 1:940 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1174
Mailing Address - Country:US
Mailing Address - Phone:575-524-5900
Mailing Address - Fax:575-524-2667
Practice Address - Street 1:940 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1174
Practice Address - Country:US
Practice Address - Phone:575-524-5900
Practice Address - Fax:575-524-2667
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00004138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist