Healthcare Provider Details

I. General information

NPI: 1932145398
Provider Name (Legal Business Name): BENZER KY 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 PARKWAY DRIVE
SALYERSVILLE KY
41465
US

IV. Provider business mailing address

5908 BRECKENRIDGE PKWY
TAMPA FL
33610
US

V. Phone/Fax

Practice location:
  • Phone: 606-349-6135
  • Fax: 606-349-6140
Mailing address:
  • Phone: 813-304-2221
  • Fax: 888-239-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP02347
License Number StateKY

VIII. Authorized Official

Name: MR. ALPESH PATEL
Title or Position: OWNER
Credential:
Phone: 813-304-2221