Provider Demographics
NPI:1649801531
Name:THOMASON, BENITA (PHARMD)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:THOMASON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S WEST AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5934
Mailing Address - Country:US
Mailing Address - Phone:870-863-7996
Mailing Address - Fax:866-566-3795
Practice Address - Street 1:220 S WEST AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5934
Practice Address - Country:US
Practice Address - Phone:870-863-7996
Practice Address - Fax:866-566-3795
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist