Provider Demographics
NPI:1447491782
Name:BENJAMIN, HANY SAMUEL (PHARMACIST)
Entity type:Individual
Prefix:
First Name:HANY
Middle Name:SAMUEL
Last Name:BENJAMIN
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 1:36919 COOK ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6069
Mailing Address - Country:US
Mailing Address - Phone:760-340-3248
Mailing Address - Fax:760-340-3258
Practice Address - Street 1:36919 COOK ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211
Practice Address - Country:US
Practice Address - Phone:760-340-3248
Practice Address - Fax:760-340-3258
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6446470001Medicare NSC