Healthcare Provider Details

I. General information

NPI: 1053045187
Provider Name (Legal Business Name): BENJAMIN MARTIN MCGINNIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 DIXIE HWY
FORT MITCHELL KY
41017-2902
US

IV. Provider business mailing address

1688 FIELDCREST DR
LAWRENCEBURG IN
47025-9379
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-0078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03442117
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26030024A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number022996
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: