Provider Demographics
NPI:1992231815
Name:BIENESTAR LLC
Entity type:Organization
Organization Name:BIENESTAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-805-7991
Mailing Address - Street 1:799 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-1734
Mailing Address - Country:US
Mailing Address - Phone:856-805-7991
Mailing Address - Fax:856-282-6706
Practice Address - Street 1:799 EMERSON ST
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-1734
Practice Address - Country:US
Practice Address - Phone:856-805-7991
Practice Address - Fax:856-282-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007555003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169241OtherPK