Provider Demographics
NPI:1205246840
Name:CULLER, BEN
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:CULLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LAKESIDE CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:IN
Mailing Address - Zip Code:46737-7101
Mailing Address - Country:US
Mailing Address - Phone:517-279-3310
Mailing Address - Fax:
Practice Address - Street 1:620 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-9497
Practice Address - Country:US
Practice Address - Phone:517-279-3310
Practice Address - Fax:517-279-3365
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020325061835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy