Provider Demographics
NPI:1578634010
Name:COUNCIL, BENITA PATRICIA (RPH)
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:PATRICIA
Last Name:COUNCIL
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 1:3532 W 82ND ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1235
Mailing Address - Country:US
Mailing Address - Phone:323-778-5464
Mailing Address - Fax:323-758-6522
Practice Address - Street 1:3532 W 82ND ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1235
Practice Address - Country:US
Practice Address - Phone:323-778-5464
Practice Address - Fax:323-758-6522
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist