Provider Demographics
NPI:1699081976
Name:JARZYNA, BENSON (B PHARM)
Entity type:Individual
Prefix:MR
First Name:BENSON
Middle Name:
Last Name:JARZYNA
Suffix:
Gender:F
Credentials:B PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 NIAGARA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3115
Mailing Address - Country:US
Mailing Address - Phone:619-222-2267
Mailing Address - Fax:
Practice Address - Street 1:4840 NIAGARA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3115
Practice Address - Country:US
Practice Address - Phone:619-222-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist