Provider Demographics
NPI:1144337064
Name:RACHWAL, BENJAMIN M (RPH)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:RACHWAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 W NAVAJO ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1940
Mailing Address - Country:US
Mailing Address - Phone:765-463-2600
Mailing Address - Fax:
Practice Address - Street 1:482 W NAVAJO ST STE A
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1940
Practice Address - Country:US
Practice Address - Phone:765-463-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist