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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

NPI # 1205642592
Entity Organization
Organization subpart 1 Not specified
Enumeration date 12/10/2024
Last updated 07/22/2025 - About 11 months ago
Identifiers
CA License # PHY59418
Other 0510239 NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS
CA Other PHY59418 CALIFORNIA STATE BOARD OF PHARMACY
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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