Provider Demographics
NPI:1952542292
Name:BENJAMIN, GENEVIEVE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17332 VON KARMAN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6280
Mailing Address - Country:US
Mailing Address - Phone:949-393-5780
Mailing Address - Fax:949-393-5790
Practice Address - Street 1:17332 VON KARMAN AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614
Practice Address - Country:US
Practice Address - Phone:949-393-5780
Practice Address - Fax:949-393-5790
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist