Healthcare Provider Details

I. General information

NPI: 1962787630
Provider Name (Legal Business Name): BENJAMIN WATKINS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEN WATKINS PHARMD

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 W CHERRY LN STE 100
MERIDIAN ID
83642-1102
US

IV. Provider business mailing address

10580 W USTICK RD
BOISE ID
83704-5267
US

V. Phone/Fax

Practice location:
  • Phone: 208-288-1496
  • Fax: 208-288-1812
Mailing address:
  • Phone: 208-377-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP6529
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6529
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: