Provider Demographics
NPI:1427658046
Name:BENNETT, DARRELL R (PHARMD)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:R
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 E 280 N
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-7591
Mailing Address - Country:US
Mailing Address - Phone:435-650-3294
Mailing Address - Fax:
Practice Address - Street 1:2255 N UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1588
Practice Address - Country:US
Practice Address - Phone:385-219-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7087326-1701333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy