Healthcare Provider Details

I. General information

NPI: 1962401547
Provider Name (Legal Business Name): JUSTUS BENJAMIN JR. P.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 PARKWAY DR ALVARADO PARKWAY INSTITUTE
LA MESA CA
91942-1535
US

IV. Provider business mailing address

9210 WISTER DR
LA MESA CA
91941-4138
US

V. Phone/Fax

Practice location:
  • Phone: 619-667-6070
  • Fax: 619-667-6035
Mailing address:
  • Phone: 619-742-3087
  • Fax: 619-469-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33174
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number33174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: