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General NPI Number Information
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NPI Number | 1043317969
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Entity Type | Organization
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Legal Business Name | BENZER CO 1 LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 568 US HWY 36
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City | BYERS
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State | CO
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Zip | 80103
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Country | US
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Telephone | 303-822-9371
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Fax | 303-822-9746
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Provider Business Mailing Address
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Address Line | 568 US HWY 36
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City | BYERS
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State | CO
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Zip | 80103
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Country | US
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Telephone | 303-822-9371
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Fax | 303-822-9746
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. SIDDHARTH V PATEL
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Credential | RPH
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Telephone | 813-723-4111
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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 | PDO.112000001
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License Number State | CO
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