Healthcare Provider Details

I. General information

NPI: 1013524990
Provider Name (Legal Business Name): BENJAMIN KURTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N CANNON AVE
HAGERSTOWN MD
21740-4918
US

IV. Provider business mailing address

25 N CANNON AVE
HAGERSTOWN MD
21740-4918
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-3451
  • Fax:
Mailing address:
  • Phone: 516-318-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30586
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: