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General NPI Number Information
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NPI Number | 1114149507
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Entity Type | Individual
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Provider Name | BOBBY BENSON
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2671 LAS VEGAS BLVD NORTH
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City | N. LAS VEGAS
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State | NV
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Zip | 89030
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Country | US
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Telephone | 702-649-3529
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Fax | 702-642-5102
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Provider Business Mailing Address
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Address Line | 6235 IGINLAS GOAL AVENUE
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City | LAS VEGAS
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State | NV
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Zip | 89131
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Country | US
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Telephone | 702-528-5336
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Fax | 702-642-5102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13553
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License Number State | NV
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