Provider Demographics
NPI:1750509246
Name:BENEFIELD, AMY D (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:BENEFIELD
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 1:234 BRANDY CREEK CIR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-2332
Mailing Address - Country:US
Mailing Address - Phone:321-953-4792
Mailing Address - Fax:
Practice Address - Street 1:190 MALABAR RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2937
Practice Address - Country:US
Practice Address - Phone:321-984-2575
Practice Address - Fax:321-984-5171
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist