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Contact Information

JEFFREY R BENNETT
2005 S MARIPOSA RD
STOCKTON, CA95205
 Phone: 209-464-7722
 Fax: 209-464-3780
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for JEFFREY R BENNETT · (Male)

NPI Number 1205642592
Status Active
Credentials
Entity Individual
Enumeration date 12/10/2024
Last updated 07/22/2025 - About 11 months ago
Sole proprietor 1 Yes
Identifiers
  • CA License # PHY59418
  • Other 0510239 NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS
  • CA Other PHY59418 CALIFORNIA STATE BOARD OF PHARMACY
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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