Provider Demographics
NPI:1891001418
Name:BENJAMIN, JENNIFER MAE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:BENJAMIN
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MAE
Other - Last Name:LOVING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2407 N RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1393
Mailing Address - Country:US
Mailing Address - Phone:319-931-6351
Mailing Address - Fax:
Practice Address - Street 1:1010 W MADISON ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1624
Practice Address - Country:US
Practice Address - Phone:319-331-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023349183500000X
IL051303742183500000X
IA21841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist