Healthcare Provider Details

I. General information

NPI: 1902556830
Provider Name (Legal Business Name): BENJAMIN CONDRA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 W BAPTIST RD
COLORADO SPRINGS CO
80921-2423
US

IV. Provider business mailing address

3250 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4077
US

V. Phone/Fax

Practice location:
  • Phone: 719-488-2988
  • Fax:
Mailing address:
  • Phone: 719-866-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number019222
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03132149
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0023266
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: