Healthcare Provider Details

I. General information

NPI: 1043337652
Provider Name (Legal Business Name): ROBERT WILSON BENEDICT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11732 SYLVESTER DR
ELSAH IL
62028-7020
US

IV. Provider business mailing address

11732 SYLVESTER DR
ELSAH IL
62028-7020
US

V. Phone/Fax

Practice location:
  • Phone: 618-802-0802
  • Fax:
Mailing address:
  • Phone: 618-374-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045307
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-290176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: