Provider Demographics
NPI:1194145730
Name:BENSON, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BENSON
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 1:1705 N BARRON ST
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9276
Mailing Address - Country:US
Mailing Address - Phone:937-456-4201
Mailing Address - Fax:
Practice Address - Street 1:1705 N BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9276
Practice Address - Country:US
Practice Address - Phone:937-456-4201
Practice Address - Fax:937-456-2751
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03117301183500000X
KY010051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist