Provider Demographics
NPI:1386259075
Name:LEITZINGER, BENJAMIN (RPH; PHARMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LEITZINGER
Suffix:
Gender:M
Credentials:RPH; PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 CHADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4465
Mailing Address - Country:US
Mailing Address - Phone:608-482-0754
Mailing Address - Fax:
Practice Address - Street 1:125 S THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2526
Practice Address - Country:US
Practice Address - Phone:608-837-8002
Practice Address - Fax:608-338-0841
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18000-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist