MEDICARE: ANTONINA BENOIT

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	183500000X	Pharmacist	67826	CA

General Provider Information

NPI Number	:	1588475461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONINA BENOIT

Provider Business Mailing Address
First Line	:	471 SAILBOAT CIR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-1505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 PONCE DE LEON AVE NE STE 300-1871
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-1804
Country	:	US
Telephone Number	:	818-625-9717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2025
Last Update Date	:	01/18/2025

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