Provider Demographics
NPI:1164805016
Name:BENZER FL 3 LLC
Entity Type:Organization
Organization Name:BENZER FL 3 LLC
Other - Org Name:ELITE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-529-2851
Mailing Address - Street 1:901 W INDIATOWN ROAD
Mailing Address - Street 2:BAY 23
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-529-2851
Mailing Address - Fax:561-529-2874
Practice Address - Street 1:901 W INDIATOWN ROAD
Practice Address - Street 2:BAY 23
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-529-2851
Practice Address - Fax:561-529-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH292203336C0003X, 3336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102220000Medicaid
2152983OtherPK
FL015846400Medicaid