Provider Demographics
NPI:1164704144
Name:BENEDETTI, ROGER L
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:BENEDETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4417
Mailing Address - Country:US
Mailing Address - Phone:732-928-6246
Mailing Address - Fax:732-928-6271
Practice Address - Street 1:430 HARMONY RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4417
Practice Address - Country:US
Practice Address - Phone:732-928-6246
Practice Address - Fax:732-928-6271
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02267900183500000X
FLPS40952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist