Provider Demographics
NPI:1821154410
Name:BENAIN, CHARLES STEVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STEVEN
Last Name:BENAIN
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 1:5061 N PULASKI RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2706
Mailing Address - Country:US
Mailing Address - Phone:773-463-2157
Mailing Address - Fax:773-463-2583
Practice Address - Street 1:5061 N PULASKI RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2706
Practice Address - Country:US
Practice Address - Phone:773-463-2157
Practice Address - Fax:773-463-2583
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist