Provider Demographics
NPI:1326876814
Name:FINE, BENJAMIN BROOK (PHARMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BROOK
Last Name:FINE
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 1:655 HIDDEN VALLEY CLUB DR APT 217
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-8007
Mailing Address - Country:US
Mailing Address - Phone:734-395-9291
Mailing Address - Fax:
Practice Address - Street 1:14288 W OLD US HWY 12
Practice Address - Street 2:SUITE 200
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-475-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024143711835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist