Provider Demographics
NPI:1316524226
Name:DO, BEN PHONG (RPH)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:PHONG
Last Name:DO
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 1:110 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2300
Mailing Address - Country:US
Mailing Address - Phone:716-507-7130
Mailing Address - Fax:
Practice Address - Street 1:110 E BROADWAY
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2300
Practice Address - Country:US
Practice Address - Phone:315-598-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist