Basic Information
| Provider Information | |||||||||
| NPI: | 1134656754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3462 STERNS RD | ||||||||
| Address2: | |||||||||
| City: | LAMBERTVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481449576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348542690 | ||||||||
| FaxNumber: | 7348542980 | ||||||||
| Practice Location | |||||||||
| Address1: | 2142 N COVE BLVD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192915418 | ||||||||
| FaxNumber: | 4194796927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2017 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 5302034062 | MI | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1200X | 03225276 | OH | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.