Eliodoro Q. Benavidez, RPH

Key facts

NPI

1750489795

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

22527 (TX)

Practice address

3600 Memorial Blvd
VA Medical Center Pharmacy SRV
Kerrville, TX 78028-5768

Phone

(830) 792-2422

NPI assigned

Sep 21, 2006

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Pharmacist

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750489795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 BOW LN",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780283708",
            "telephone_number": "830-896-4952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 MEMORIAL BLVD",
            "address_2": "VA MEDICAL CENTER PHARMACY SRV",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780285768",
            "telephone_number": "830-792-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENAVIDEZ",
        "first_name": "ELIODORO",
        "middle_name": "Q.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "22527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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