Organization
GARY BENTON INC
Active
Other names
MARSHALL ROAD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BENTON (OWNER)
(501) 982-3551
Entity
Organization
Contact information
Practice address
811 MARSHALL RD, JACKSONVILLE, AR 72076-3744
(501) 982-3551
(501) 982-2010
Mailing address
811 MARSHALL RD, JACKSONVILLE, AR 72076-3744
(501) 982-3551
(501) 982-2010
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20238
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140212407
—
AR
01
—
1994535
PK
—
Enumeration date
02/08/2007
Last updated
04/13/2017
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