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General NPI Number Information
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NPI Number | 1285787705
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Entity Type | Organization
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Legal Business Name | BEN-DEE CORP
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/02/2007
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Provider Practice Location Address
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Address Line | 2151 IDLEWOOD RD
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City | TUCKER
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State | GA
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Zip | 30084-4816
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Country | US
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Telephone | 770-939-4333
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Fax | 770-491-3061
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Provider Business Mailing Address
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Address Line | 2151 IDLEWOOD RD
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City | TUCKER
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State | GA
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Zip | 30084-4816
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Country | US
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Telephone | 770-939-4333
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Fax | 770-491-3061
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Authorized Official
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Title or Position | MGR
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Name | MR. BRADLEY BENTON PIERCY JR.
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Credential | R.PH
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Telephone | 770-939-4333
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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 | RPH015404
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License Number State | GA
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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 | PHRE006480
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License Number State | GA
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