Organization
JEFFREY RYAN BENNETT
Active
Organization
JEFFREY RYAN BENNETT
Active
Other names
El Dorado Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY BENNETT (OWNER)
(209) 464-7722
Entity
Organization
Contact information
Practice address
2005 S MARIPOSA RD, STOCKTON, CA 95205-7735
(209) 464-7722
(209) 464-7404
Mailing address
2005 S MARIPOSA RD, STOCKTON, CA 95205-7735
(209) 464-7722
(209) 464-7404
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0510239
NCPDP
—
05
—
1205642592
—
CA
01
—
PHY59418
CALIFORNIA STATE BOARD OF PHARMACY
CA
Enumeration date
09/13/2006
Last updated
09/16/2025
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