Provider Demographics
NPI:1093202046
Name:BENZENE KHEMIKALS
Entity Type:Organization
Organization Name:BENZENE KHEMIKALS
Other - Org Name:BELMONT PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-528-5336
Mailing Address - Street 1:3050 E BONANZA RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3703
Mailing Address - Country:US
Mailing Address - Phone:702-778-8087
Mailing Address - Fax:702-675-3984
Practice Address - Street 1:3050 E BONANZA RD STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3707
Practice Address - Country:US
Practice Address - Phone:702-778-8087
Practice Address - Fax:702-675-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NVPH0308793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177368OtherPK
NV1093202046Medicaid