Provider Demographics
NPI:1164569810
Name:DAVID BENSON INC
Entity Type:Organization
Organization Name:DAVID BENSON INC
Other - Org Name:KAYES EPIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BENSON
Authorized Official - Last Name:LIEBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-665-5192
Mailing Address - Street 1:6913 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1123
Mailing Address - Country:US
Mailing Address - Phone:410-665-5192
Mailing Address - Fax:410-668-8533
Practice Address - Street 1:6913 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1123
Practice Address - Country:US
Practice Address - Phone:410-665-5192
Practice Address - Fax:410-668-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP003593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0845180001Medicare NSC