Provider Demographics
NPI:1174979041
Name:BENTLEY, MARK THOMAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:BENTLEY
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 1:11320 MONTWOOD DR
Mailing Address - Street 2:ALBERTSONS PHARMACY #1016
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4383
Mailing Address - Country:US
Mailing Address - Phone:915-857-6987
Mailing Address - Fax:
Practice Address - Street 1:11320 MONTWOOD DR
Practice Address - Street 2:ALBERTSONS PHARMACY #1016
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4383
Practice Address - Country:US
Practice Address - Phone:915-857-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX433711835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care