Provider Demographics
NPI:1982046546
Name:BENSON, ANDREW WILLIAM
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLIAM
Last Name:BENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 CALUMET WAY
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-9444
Mailing Address - Country:US
Mailing Address - Phone:270-870-1111
Mailing Address - Fax:
Practice Address - Street 1:2005 CALUMET WAY
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-9444
Practice Address - Country:US
Practice Address - Phone:270-870-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2024-11-29
Deactivation Date:2019-03-05
Deactivation Code:
Reactivation Date:2024-11-26
Provider Licenses
StateLicense IDTaxonomies
ARPD13711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist