Healthcare Provider Details

I. General information

NPI: 1255870127
Provider Name (Legal Business Name): BENAK INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 N 22ND ST
TAMPA FL
33605-1937
US

IV. Provider business mailing address

3209 N 22ND ST
TAMPA FL
33605-1937
US

V. Phone/Fax

Practice location:
  • Phone: 813-231-7788
  • Fax: 813-232-5210
Mailing address:
  • Phone: 813-231-7788
  • Fax: 813-232-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH30610
License Number StateFL

VIII. Authorized Official

Name: SMRUTHI JANNU
Title or Position: OWNER, PHARMACY MANAGER,PIC,AO
Credential:
Phone: 813-231-7799