=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821085341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA M BENINCASA RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 MEACHAM AVE
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-2630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-354-2950
-----------------------------------------------------
Fax | 516-354-3375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 683 ANDERSON AVE
-----------------------------------------------------
City | FRANKLIN SQUARE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11010-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-489-2940
-----------------------------------------------------
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 | 040276
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------