Provider Demographics
NPI:1063231652
Name:MCWILLIAMS, BENJAMIN LANE (RPH)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LANE
Last Name:MCWILLIAMS
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 1:14447 SENECA TRL
Mailing Address - Street 2:
Mailing Address - City:HUTTONSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26273-9723
Mailing Address - Country:US
Mailing Address - Phone:304-940-2326
Mailing Address - Fax:
Practice Address - Street 1:615 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3950
Practice Address - Country:US
Practice Address - Phone:304-636-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0013742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist