Provider Demographics
NPI:1538483904
Name:BENITEZ, CARLOS EDUARDO (RPH)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDUARDO
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:17502-9712
Mailing Address - Country:US
Mailing Address - Phone:717-361-9401
Mailing Address - Fax:
Practice Address - Street 1:1605 S MARKET ST
Practice Address - Street 2:KMART PHARMACY 3963
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2852
Practice Address - Country:US
Practice Address - Phone:717-361-8024
Practice Address - Fax:717-361-8002
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040463R183500000X
MD11731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist