Provider Demographics
NPI:1528661790
Name:GUERRA, BENJAMIN JOSE (PHARMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOSE
Last Name:GUERRA
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 1:1521 NORTH QUAKER LANE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302
Mailing Address - Country:US
Mailing Address - Phone:703-998-6560
Mailing Address - Fax:
Practice Address - Street 1:1521 NORTH QUAKER LANE
Practice Address - Street 2:
Practice Address - City:ALEXANDIRA
Practice Address - State:VA
Practice Address - Zip Code:22302
Practice Address - Country:US
Practice Address - Phone:703-998-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist