Provider Demographics
NPI:1245819804
Name:BENCIC, LINDA LEE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:BENCIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4331
Mailing Address - Country:US
Mailing Address - Phone:440-667-3166
Mailing Address - Fax:
Practice Address - Street 1:9303 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6413
Practice Address - Country:US
Practice Address - Phone:440-974-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03313418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist