Provider Demographics
NPI:1700153343
Name:BENTON, CARL DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:DEAN
Last Name:BENTON
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 1:2700 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-1903
Mailing Address - Country:US
Mailing Address - Phone:620-669-3113
Mailing Address - Fax:620-669-1894
Practice Address - Street 1:2700 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-1903
Practice Address - Country:US
Practice Address - Phone:620-669-3113
Practice Address - Fax:620-669-1894
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS12254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist