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General NPI Number Information
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NPI Number | 1003330580
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Entity Type | Organization
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Legal Business Name | BENZER PHARMACY EATONTON LLC
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 228 N JEFFERSON AVE
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City | EATONTON
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State | GA
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Zip | 31024-1022
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Country | US
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Telephone | 706-816-2879
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Fax | 706-927-9073
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Provider Business Mailing Address
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Address Line | 228 N JEFFERSON AVE
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City | EATONTON
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State | GA
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Zip | 31024-1022
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Country | US
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Telephone | 706-816-2879
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Fax | 706-927-9073
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ROBERT S STINSON
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Credential |
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Telephone | 678-521-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE010369
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License Number State | GA
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