Provider Demographics
NPI:1255870127
Name:BENAK INCORPORATED
Entity Type:Organization
Organization Name:BENAK INCORPORATED
Other - Org Name:TAMPA DRUGS AND DIABETIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHARMACY MANAGER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:SMRUTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-231-7799
Mailing Address - Street 1:3209 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-1937
Mailing Address - Country:US
Mailing Address - Phone:813-231-7788
Mailing Address - Fax:813-232-5210
Practice Address - Street 1:3209 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-1937
Practice Address - Country:US
Practice Address - Phone:813-231-7788
Practice Address - Fax:813-232-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
FLPH306103336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167657OtherPK