Provider Demographics
NPI:1568643153
Name:BENGTSON, SHERRIE LYNNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:LYNNE
Last Name:BENGTSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1008
Mailing Address - Country:US
Mailing Address - Phone:716-827-8333
Mailing Address - Fax:716-826-3924
Practice Address - Street 1:798 HARLEM RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1008
Practice Address - Country:US
Practice Address - Phone:716-827-8333
Practice Address - Fax:716-826-3924
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-25
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00484331Medicaid