Provider Demographics
NPI:1730782830
Name:BENJAMIN, VERNON H
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:H
Last Name:BENJAMIN
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 1:1537 270TH ST
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:IA
Mailing Address - Zip Code:52619-9658
Mailing Address - Country:US
Mailing Address - Phone:319-470-3782
Mailing Address - Fax:
Practice Address - Street 1:1537 270TH ST
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:IA
Practice Address - Zip Code:52619-9658
Practice Address - Country:US
Practice Address - Phone:319-470-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist