Provider Demographics
NPI:1629658521
Name:BENIAMIN, WAEL S (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:WAEL
Middle Name:S
Last Name:BENIAMIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13033 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-4838
Mailing Address - Country:US
Mailing Address - Phone:352-610-4455
Mailing Address - Fax:352-610-4439
Practice Address - Street 1:13033 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-4838
Practice Address - Country:US
Practice Address - Phone:352-610-4455
Practice Address - Fax:352-610-4439
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001734700Medicaid