Provider Demographics
NPI:1902985146
Name:BENSON, CATRINA G
Entity type:Individual
Prefix:MRS
First Name:CATRINA
Middle Name:G
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 YELLOW LEAF RD
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2048
Mailing Address - Country:US
Mailing Address - Phone:205-280-1595
Mailing Address - Fax:
Practice Address - Street 1:640 OLLIE AVE.
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045
Practice Address - Country:US
Practice Address - Phone:205-755-1711
Practice Address - Fax:205-755-9601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist