Benton Southgate Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BENTON SOUTHGATE PHARMACY INC

Practice address

471 Wine Country Road
Prosser, WA 99350

Phone

(509) 781-6520

Fax

(509) 781-6523

NPI assigned

May 22, 2020

Last updated

Jul 14, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lateef Ajani Olaniyan, PHARM. D

Title

President

Phone

(509) 750-8319

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1306469580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 WINE COUNTRY ROAD",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "99350",
            "telephone_number": "509-750-8319",
            "fax_number": "509-765-4761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 WINE COUNTRY ROAD",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "99350",
            "telephone_number": "509-781-6520",
            "fax_number": "509-781-6523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENTON SOUTHGATE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-22",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "OLANIYAN",
        "authorized_official_first_name": "LATEEF",
        "authorized_official_middle_name": "AJANI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-750-8319",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM. D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Constance Abigail Asiedu-Ofei, MD
• Heather Rae Avelar I
• Maria Guadalupe Ayala
• Bonnie Bair
• Reece Michael Bauman
• Alison Bestebreur, RN
• Karan Bhatti
• Sandra L Birdlebough, PHD, ARNP
• Amy Lue Biskovich, LMP
• Colton Warner Blair, LMP

• Community/Retail Pharmacy in Prosser, WA
• Providers in Prosser, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.