Provider Demographics
NPI:1992294292
Name:MCNABB, BENJAMIN CARSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CARSON
Last Name:MCNABB
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 1:805 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-2536
Mailing Address - Country:US
Mailing Address - Phone:254-629-1791
Mailing Address - Fax:254-629-3177
Practice Address - Street 1:805 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2536
Practice Address - Country:US
Practice Address - Phone:254-629-1791
Practice Address - Fax:254-629-3177
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist