Healthcare Provider Details

I. General information

NPI: 1225049885
Provider Name (Legal Business Name): BENZER OH 5 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 N MAIN ST
UTICA OH
43080-7705
US

IV. Provider business mailing address

5908 BRECKENRIDGE PARKWAY
TAMPA FL
33610
US

V. Phone/Fax

Practice location:
  • Phone: 740-892-2971
  • Fax: 740-892-3075
Mailing address:
  • Phone: 813-304-2221
  • Fax: 888-239-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021529950
License Number StateOH

VIII. Authorized Official

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