Provider Demographics
NPI:1073862769
Name:MICHAEL, BENNY CHEMMACHERIL (PHARMD)
Entity type:Individual
Prefix:
First Name:BENNY
Middle Name:CHEMMACHERIL
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STONELEA PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4506
Mailing Address - Country:US
Mailing Address - Phone:914-500-3719
Mailing Address - Fax:
Practice Address - Street 1:1606 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5301
Practice Address - Country:US
Practice Address - Phone:203-377-2851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist