Provider Demographics
NPI:1114477122
Name:BENECORD CENTRAL FILL OF FL LLC
Entity Type:Organization
Organization Name:BENECORD CENTRAL FILL OF FL LLC
Other - Org Name:BENECARD CENTRAL FILL OF FL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-458-9191
Mailing Address - Street 1:27090 BAY LANDING DRIVE
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:888-907-0090
Mailing Address - Fax:888-907-0040
Practice Address - Street 1:28000 SPANISH WELLS BLVD
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-2850
Practice Address - Country:US
Practice Address - Phone:888-907-0090
Practice Address - Fax:888-907-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165950OtherPK