Jeffrey Ryan Bennett

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

JEFFREY RYAN BENNETT

Doing business as

El Dorado Drug Store

Practice address

2005 S Mariposa Rd
Stockton, CA 95205-7735

Phone

(209) 464-7722

Fax

(209) 464-7404

NPI assigned

Sep 13, 2006

Last updated

Sep 16, 2025By 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

Jeffrey BennettNPI 1205642592

Title

Owner

Phone

(209) 464-7722

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• El Dorado Drug Store Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Ryan Bennett

  • Community/Retail Pharmacy
  • Stockton, CA
  • NPI 1205642592
  NPD Authorized official
• Frank Paul Precissi, PHARMD

  • Pharmacist
  • Stockton, CA
  • NPI 1437328226
  NPD

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757980800000",
    "number": "1417052937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 S MARIPOSA RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952057735",
            "telephone_number": "209-464-7722",
            "fax_number": "209-464-7404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 S MARIPOSA RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952057735",
            "telephone_number": "209-464-7722",
            "fax_number": "209-464-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY RYAN BENNETT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-464-7722"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE BOARD OF PHARMACY",
            "identifier": "PHY59418",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0510239",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205642592",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Dorado Drug Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "El Dorado Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Stockton, CA
• Providers in Stockton, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; 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.