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NPI Code Detail

MEDICARE: DR. TRACY LYNN BENAVIDES PHARM.D.

MEDICARE: DR. TRACY LYNN BENAVIDES PHARM.D.
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
1183500000XPharmacist42520TX

General Provider Information

NPI Number : 1427268697
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACY LYNN BENAVIDES PHARM.D.
Provider Business Mailing Address
First Line : 1260 COUNTRY VIEW DR
Second Line :
City : LA VERNIA
State : TX
Zip : 78121-4739
Country : US
Telephone Number : 830-660-8652
Fax Number :
Provider Business Practice Location Address
First Line : 6520 FRATT RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78218-4402
Country : US
Telephone Number : 210-938-9707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 02/26/2013

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