Provider Demographics
NPI:1811273881
Name:BEN-RAY INC DBA PROVIDERX
Entity type:Organization
Organization Name:BEN-RAY INC DBA PROVIDERX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENTLEY
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:432-337-2361
Mailing Address - Street 1:2208 N LOOP 250 W # 101
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-6011
Mailing Address - Country:US
Mailing Address - Phone:432-689-3355
Mailing Address - Fax:
Practice Address - Street 1:2208 N LOOP 250 W # 101
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-6011
Practice Address - Country:US
Practice Address - Phone:432-689-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEN-RAY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-22
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277023336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27702OtherSTATE LICENSE