Provider Demographics
NPI:1952626871
Name:PARDO, BENJAMIN A (RPH)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:A
Last Name:PARDO
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 1:198 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2118
Mailing Address - Country:US
Mailing Address - Phone:516-414-3586
Mailing Address - Fax:
Practice Address - Street 1:747 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5423
Practice Address - Country:US
Practice Address - Phone:631-654-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-03
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist