MEDICARE: BENCKALL GROUP INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	17517	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2105513	OTHER	PK

General Provider Information

NPI Number	:	1396838744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENCKALL GROUP INCORPORATED

Provider Business Mailing Address
First Line	:	4302 CENTER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5616
Country	:	US
Telephone Number	:	713-864-0808
Fax Number	:	713-864-2153

Provider Business Practice Location Address
First Line	:	4302 CENTER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5616
Country	:	US
Telephone Number	:	713-864-0808
Fax Number	:	713-864-2153

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CYPRIAN EZEUDE
Credential	:	RPH
Telephone Number	:	713-864-0808

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	04/05/2022

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Directions to “BENCKALL GROUP INCORPORATED ” Practice Location

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