Provider Demographics
NPI:1477789758
Name:BABY, BENCY ANNIE
Entity Type:Individual
Prefix:
First Name:BENCY
Middle Name:ANNIE
Last Name:BABY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BENCY
Other - Middle Name:ANNIE
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8380 OPAL DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3761
Mailing Address - Country:US
Mailing Address - Phone:734-422-4863
Mailing Address - Fax:
Practice Address - Street 1:35363 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3171
Practice Address - Country:US
Practice Address - Phone:734-728-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist