Provider Demographics
NPI:1003330580
Name:BENZER PHARMACY EATONTON LLC
Entity Type:Organization
Organization Name:BENZER PHARMACY EATONTON LLC
Other - Org Name:HOMETOWN PHARMACY EATONTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-521-3820
Mailing Address - Street 1:228 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-1022
Mailing Address - Country:US
Mailing Address - Phone:706-816-2879
Mailing Address - Fax:706-927-9073
Practice Address - Street 1:228 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-1022
Practice Address - Country:US
Practice Address - Phone:706-816-2879
Practice Address - Fax:706-927-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0103693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy