Individual
JEFFREY RYAN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2005 S MARIPOSA RD, STOCKTON, CA 95205
(209) 464-7722
(209) 464-3780
Mailing address
2005 S MARIPOSA RD, STOCKTON, CA 95205
(209) 464-7722
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY59418
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0510239
NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS
—
01
—
PHY59418
CALIFORNIA STATE BOARD OF PHARMACY
CA
Enumeration date
12/10/2024
Last updated
07/22/2025
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