Provider Demographics
NPI:1821106287
Name:BENSON DRUG COMPANY INC.
Entity Type:Organization
Organization Name:BENSON DRUG COMPANY INC.
Other - Org Name:BENSON DRUG COMPANY INC.-SAV-MOR #17
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:BENSON
Authorized Official - Last Name:DAHLQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-722-2861
Mailing Address - Street 1:961 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3278
Mailing Address - Country:US
Mailing Address - Phone:231-722-2861
Mailing Address - Fax:231-726-5522
Practice Address - Street 1:961 SPRING ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3278
Practice Address - Country:US
Practice Address - Phone:231-722-2861
Practice Address - Fax:231-726-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010008923336C0003X
MI3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649519Medicaid
2310009OtherOTHER ID NUMBER
2310009OtherNABP
MI2310009Medicaid
MI1649519Medicaid
485-445-000-1Medicare UPIN