Provider Demographics
NPI:1225509649
Name:BENIPAL, PRABHJOT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PRABHJOT
Middle Name:
Last Name:BENIPAL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 MARSH CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4644
Mailing Address - Country:US
Mailing Address - Phone:916-230-0551
Mailing Address - Fax:
Practice Address - Street 1:4601 2ND ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-9446
Practice Address - Country:US
Practice Address - Phone:530-761-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA788871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA78887OtherCALIFORNIA STATE PHARMACIST LICENSE