=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750489795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIODORO Q. BENAVIDEZ RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 MEMORIAL BLVD VA MEDICAL CENTER PHARMACY SRV
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-5768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-792-2422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 BOW LN
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-896-4952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 22527
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------