Provider Demographics
NPI:1255324836
Name:BEN-RAY INC.
Entity Type:Organization
Organization Name:BEN-RAY INC.
Other - Org Name:EVANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENTLEY
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-337-2361
Mailing Address - Street 1:PO BOX 4474
Mailing Address - Street 2:310 N. DOTSY AVE
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-4474
Mailing Address - Country:US
Mailing Address - Phone:432-337-2361
Mailing Address - Fax:432-337-0310
Practice Address - Street 1:310 DOTSY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4342
Practice Address - Country:US
Practice Address - Phone:432-337-2361
Practice Address - Fax:432-337-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01918333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140119Medicaid
0556250001Medicare ID - Type Unspecified