Provider Demographics
NPI:1831390541
Name:BENJAMIN, MARCEL E
Entity type:Individual
Prefix:
First Name:MARCEL
Middle Name:E
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCEL
Other - Middle Name:
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2845 VER CRUZ STREET
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:951-317-8661
Mailing Address - Fax:
Practice Address - Street 1:1525 MESA VERDE DR E STE 101
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5221
Practice Address - Country:US
Practice Address - Phone:714-904-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPH11442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist