Healthcare Provider Details

I. General information

NPI: 1285917500
Provider Name (Legal Business Name): BENJAMIN OBI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5623 S ZANTE CIR
AURORA CO
80015-6760
US

IV. Provider business mailing address

5623 S ZANTE CIR
AURORA CO
80015-6760
US

V. Phone/Fax

Practice location:
  • Phone: 719-209-8200
  • Fax:
Mailing address:
  • Phone: 719-209-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number18276
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: