Provider Demographics
NPI:1962787630
Name:WATKINS, BENJAMIN (PHARMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10580 W USTICK RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5267
Mailing Address - Country:US
Mailing Address - Phone:208-377-3581
Mailing Address - Fax:
Practice Address - Street 1:10580 W USTICK RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5267
Practice Address - Country:US
Practice Address - Phone:208-377-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist