Provider Demographics
NPI:1528663093
Name:JOHN, BENSON BENNY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BENSON
Middle Name:BENNY
Last Name:JOHN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W ROCHELLE RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5616
Mailing Address - Country:US
Mailing Address - Phone:972-258-6015
Mailing Address - Fax:972-570-5886
Practice Address - Street 1:410 W ROCHELLE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5616
Practice Address - Country:US
Practice Address - Phone:972-258-6015
Practice Address - Fax:972-570-5886
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist