Provider Demographics
NPI:1215233606
Name:PEARSON, BENJAMIN KARL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:KARL
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 26TH ST NW
Mailing Address - Street 2:APT 6403
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1914
Mailing Address - Country:US
Mailing Address - Phone:770-595-3963
Mailing Address - Fax:
Practice Address - Street 1:5864 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2301
Practice Address - Country:US
Practice Address - Phone:770-949-9307
Practice Address - Fax:770-949-9633
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist