Provider Demographics
NPI:1205261237
Name:BENZER FL 6 LLC
Entity type:Organization
Organization Name:BENZER FL 6 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MGRM/PHARMACIST IN CHARCHE
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-683-7059
Mailing Address - Street 1:6132 MERRILL RD
Mailing Address - Street 2:STE 12
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3459
Mailing Address - Country:US
Mailing Address - Phone:904-683-7059
Mailing Address - Fax:904-813-7934
Practice Address - Street 1:6132 MERRILL RD
Practice Address - Street 2:STE 12
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3459
Practice Address - Country:US
Practice Address - Phone:904-683-7059
Practice Address - Fax:904-813-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH293503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024188500Medicaid
2152736OtherPK