Provider Demographics
NPI:1386253581
Name:PIERSON, BENJAMIN (PHARM D)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PIERSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 DORCHESTER DR APT 198
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4029
Mailing Address - Country:US
Mailing Address - Phone:262-490-5269
Mailing Address - Fax:
Practice Address - Street 1:4612 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1826
Practice Address - Country:US
Practice Address - Phone:313-832-3247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist