MEDICARE: BENSTAR PHARMACY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301010006	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2377605	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1255679924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENSTAR PHARMACY PLLC

Provider Business Mailing Address
First Line	:	2510 E NEVADA ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1461
Country	:	US
Telephone Number	:	313-334-5859
Fax Number	:	313-733-6115

Provider Business Practice Location Address
First Line	:	2510 E NEVADA ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1461
Country	:	US
Telephone Number	:	313-334-5859
Fax Number	:	313-733-6115

Authorized Official
Title or Position	:	SUPT. PHARMACIST/MANAGER
Name	:	UZOMA NWACHUKWU
Credential	:
Telephone Number	:	313-995-2747

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	01/30/2013

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Directions to “BENSTAR PHARMACY PLLC ” Practice Location

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