Provider Demographics
NPI:1841590452
Name:BENES, GARY EDWIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:EDWIN
Last Name:BENES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 BRADDOCK RD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2539
Mailing Address - Country:US
Mailing Address - Phone:703-978-7326
Mailing Address - Fax:703-978-6091
Practice Address - Street 1:9525 BRADDOCK RD
Practice Address - Street 2:PHARMACY
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2539
Practice Address - Country:US
Practice Address - Phone:703-978-7326
Practice Address - Fax:703-978-6091
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist