Provider Demographics
NPI:1285787705
Name:BEN-DEE CORP
Entity type:Organization
Organization Name:BEN-DEE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:BENTON
Authorized Official - Last Name:PIERCY
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-939-4333
Mailing Address - Street 1:2151 IDLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4816
Mailing Address - Country:US
Mailing Address - Phone:770-939-4333
Mailing Address - Fax:770-491-3061
Practice Address - Street 1:2151 IDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4816
Practice Address - Country:US
Practice Address - Phone:770-939-4333
Practice Address - Fax:770-491-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015404183500000X
GAPHRE0064803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00389969AMedicaid
GA00389969AMedicaid