Provider Demographics
NPI:1144310319
Name:BENAK INC
Entity type:Organization
Organization Name:BENAK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SMRUTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-231-7788
Mailing Address - Street 1:1600 SW 2ND AVE # VAE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-6122
Mailing Address - Country:US
Mailing Address - Phone:863-462-4479
Mailing Address - Fax:863-462-4480
Practice Address - Street 1:1600 SW 2ND AVE # VAE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-6122
Practice Address - Country:US
Practice Address - Phone:863-462-4479
Practice Address - Fax:863-462-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH189313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019701100Medicaid
1097509OtherNABP NUMBER
BB8134570OtherDEA NUMBER