Provider Demographics
NPI:1124644463
Name:BENAK, JOSEPH HARRISON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HARRISON
Last Name:BENAK
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 1:224 FOLSOM RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4976
Mailing Address - Country:US
Mailing Address - Phone:334-701-0533
Mailing Address - Fax:
Practice Address - Street 1:141 S DALTON ST
Practice Address - Street 2:
Practice Address - City:SLOCOMB
Practice Address - State:AL
Practice Address - Zip Code:36375-5483
Practice Address - Country:US
Practice Address - Phone:334-886-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist