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General NPI Number Information
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NPI Number | 1265735518
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Entity Type | Organization
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Legal Business Name | BENZER FL 5 LLC
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 500 W GRANADA BLVD STE 4
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City | ORMOND BEACH
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State | FL
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Zip | 32174-2304
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Country | US
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Telephone | 386-672-0600
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Fax | 386-672-0700
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Provider Business Mailing Address
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Address Line | 500 W GRANADA BLVD STE 4
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City | ORMOND BEACH
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State | FL
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Zip | 32174-2304
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Country | US
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Telephone | 386-672-0600
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Fax | 888-239-8423
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Authorized Official
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Title or Position | PRESIDENT, AO
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Name | SANDRA JOHNSTON
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Credential |
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Telephone | 386-672-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH29731
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License Number State | FL
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