Healthcare Provider Details

I. General information

NPI: 1588203814
Provider Name (Legal Business Name): NAYER BENYAMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 JACKSON ST
RIVERSIDE CA
92503-3919
US

IV. Provider business mailing address

3865 JACKSON ST
RIVERSIDE CA
92503-3919
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-2211
  • Fax:
Mailing address:
  • Phone: 951-688-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number66845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: