Healthcare Provider Details

I. General information

NPI: 1073684346
Provider Name (Legal Business Name): PETER DEMETRIS BENARDIS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25825 VERMONT AVE
HARBOR CITY CA
90710-3518
US

IV. Provider business mailing address

225 W 3RD ST APT 402
LONG BEACH CA
90802-3050
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-3531
  • Fax: 310-517-4050
Mailing address:
  • Phone: 562-726-1214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH 49691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: