Provider Demographics
NPI:1235499583
Name:BENOIT, DANIEL ROSS (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROSS
Last Name:BENOIT
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 1:289 SUMMER RIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-5057
Mailing Address - Country:US
Mailing Address - Phone:337-654-5659
Mailing Address - Fax:
Practice Address - Street 1:2700 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3242
Practice Address - Country:US
Practice Address - Phone:337-232-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist