Provider Demographics
NPI:1215043930
Name:COX, BENJIE LANE (DPH)
Entity type:Individual
Prefix:DR
First Name:BENJIE
Middle Name:LANE
Last Name:COX
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 DAHLIA ST W
Mailing Address - Street 2:
Mailing Address - City:MOSHEIM
Mailing Address - State:TN
Mailing Address - Zip Code:37818-3673
Mailing Address - Country:US
Mailing Address - Phone:423-422-7915
Mailing Address - Fax:423-638-9105
Practice Address - Street 1:906 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4004
Practice Address - Country:US
Practice Address - Phone:423-638-7101
Practice Address - Fax:423-638-9105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist