Healthcare Provider Details

I. General information

NPI: 1568751030
Provider Name (Legal Business Name): MR. BENJAMIN BANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2396 HENDERSON ROAD
REDDING CA
96002
US

IV. Provider business mailing address

679 HILLTOP DR APT 5
REDDING CA
96003-3700
US

V. Phone/Fax

Practice location:
  • Phone: 530-657-0337
  • Fax: 530-245-4755
Mailing address:
  • Phone: 949-370-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH60850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: