Healthcare Provider Details

I. General information

NPI: 1528091220
Provider Name (Legal Business Name): BEN-TAL PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 BLONDELL AVE
BRONX NY
10461-2601
US

IV. Provider business mailing address

1515 BLONDELL AVE
BRONX NY
10461-2601
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-9808
  • Fax: 718-239-3523
Mailing address:
  • Phone: 718-239-9808
  • Fax: 718-239-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number025192
License Number StateNY

VIII. Authorized Official

Name: GINA HUNT
Title or Position: SENIOR VP CORPORATE REVENUE
Credential:
Phone: 954-653-1040