Provider Demographics
NPI:1699183616
Name:TRICKEY, BENJAMIN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:TRICKEY
Suffix:JR
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 1:4701 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1635
Mailing Address - Country:US
Mailing Address - Phone:913-831-9233
Mailing Address - Fax:913-831-9231
Practice Address - Street 1:4701 MISSION RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1635
Practice Address - Country:US
Practice Address - Phone:913-831-9233
Practice Address - Fax:913-831-9231
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12533183500000X
MO043789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist