Provider Demographics
NPI:1528339181
Name:BENNETT, KARL (RPH)
Entity type:Individual
Prefix:MR
First Name:KARL
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:HC 63 BOX 232
Mailing Address - Street 2:
Mailing Address - City:RED HOUSE
Mailing Address - State:WV
Mailing Address - Zip Code:25168-9610
Mailing Address - Country:US
Mailing Address - Phone:304-586-2026
Mailing Address - Fax:
Practice Address - Street 1:425 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-2708
Practice Address - Country:US
Practice Address - Phone:304-429-5544
Practice Address - Fax:304-429-3164
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005208183500000X
OHRPH. 03225087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist