Provider Demographics
NPI:1619252459
Name:BENEDETTO, JOHN J (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BENEDETTO
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 1:5506 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6410
Mailing Address - Country:US
Mailing Address - Phone:302-698-6320
Mailing Address - Fax:
Practice Address - Street 1:5506 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6410
Practice Address - Country:US
Practice Address - Phone:302-698-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA1-0002901OtherDELAWARE LICENSE NUMBER