Healthcare Provider Details

I. General information

NPI: 1376558908
Provider Name (Legal Business Name): BRIAN BENSON PHARMACIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 GREENFIELD AVE STE 101
HANFORD CA
93230-3585
US

IV. Provider business mailing address

457 GREENFIELD AVE STE 101
HANFORD CA
93230-3585
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-2022
  • Fax: 559-582-5216
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY35699
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN BENSON
Title or Position: OWNER
Credential: RPH
Phone: 559-582-2022