Provider Demographics
NPI:1932160686
Name:PAULETTE BENINATE
Entity Type:Organization
Organization Name:PAULETTE BENINATE
Other - Org Name:IV SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENINATE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-394-9037
Mailing Address - Street 1:1581 CAROL SUE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5100
Mailing Address - Country:US
Mailing Address - Phone:504-394-9037
Mailing Address - Fax:504-392-0973
Practice Address - Street 1:1581 CAROL SUE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5100
Practice Address - Country:US
Practice Address - Phone:504-394-9037
Practice Address - Fax:504-392-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3256-IR251F00000X
LA039127 003256251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1263303Medicaid
MS06394/07.1Medicaid
LA1263303Medicaid
MS06394/07.1Medicaid