Provider Demographics
NPI:1811920515
Name:BEN-TAL PHARMACY SERVICES, INC.
Entity type:Organization
Organization Name:BEN-TAL PHARMACY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP CORPORATE REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-653-1040
Mailing Address - Street 1:360 E 193RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4710
Mailing Address - Country:US
Mailing Address - Phone:718-741-9505
Mailing Address - Fax:718-741-9525
Practice Address - Street 1:360 E 193RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4710
Practice Address - Country:US
Practice Address - Phone:718-741-9505
Practice Address - Fax:718-741-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0251943336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190229Medicaid