Provider Demographics
NPI:1023788288
Name:BENVENUTTI, JORDAN (PHARM D)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BENVENUTTI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 BAY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7990
Mailing Address - Country:US
Mailing Address - Phone:228-671-6418
Mailing Address - Fax:
Practice Address - Street 1:2180 W NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9472
Practice Address - Country:US
Practice Address - Phone:850-473-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-16627183500000X
FLPS62877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist