Provider Demographics
NPI:1831283233
Name:BENHAM AND BENHAM INC
Entity Type:Organization
Organization Name:BENHAM AND BENHAM INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-425-1538
Mailing Address - Street 1:103 DYER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 DYER ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3513
Practice Address - Country:US
Practice Address - Phone:870-425-1538
Practice Address - Fax:870-425-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0420205333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR13885407Medicaid
0420808OtherOTHER ID NUMBER-COMMERCIAL NUMBER
ARBM6607634OtherDEA #
0420808OtherOTHER ID NUMBER-COMMERCIAL NUMBER