Provider Demographics
NPI:1902556830
Name:CONDRA, BENJAMIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CONDRA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4077
Mailing Address - Country:US
Mailing Address - Phone:719-866-6646
Mailing Address - Fax:
Practice Address - Street 1:3250 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4077
Practice Address - Country:US
Practice Address - Phone:614-735-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132149183500000X
COPHA.0023266183500000X
KY019222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist