Healthcare Provider Details

I. General information

NPI: 1336386788
Provider Name (Legal Business Name): ELENA S BENSONOFF R.PH., CPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 S MANHATTAN AVE
TAMPA FL
33611-1304
US

IV. Provider business mailing address

4330 SOUTH MANHATTAN AVENUE
TAMPA FL
33611
US

V. Phone/Fax

Practice location:
  • Phone: 813-839-8861
  • Fax:
Mailing address:
  • Phone: 813-839-8861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPS33868
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS33868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: