Bennett Porter Capps
Individual provider Active NPI Pharmacist · Stuttgart, AR
NPI 1003417601 · NPPES record last updated Nov 2, 2020
Key facts
- NPI
- 1003417601
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PD11061 (AR)
- Practice address
- 406 E 22ND St
Stuttgart, AR 72160-9006 - Phone
- (870) 673-1834
- NPI assigned
- Nov 2, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD11061 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past |
Accepting new patients | |
| Walmart Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD11061 | AR | Yes |
Addresses
Primary practice location
406 E 22ND St
Stuttgart, AR 72160-9006
Mailing address
406 E 22ND St
Stuttgart, AR 72160-9006
Phone (870) 673-1834
Other providers in Stuttgart, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.