Healthcare Provider Details

I. General information

NPI: 1295027902
Provider Name (Legal Business Name): BENJAMIN LE RPH, BCPS, REHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SHOSHONE CIR
ELKO NV
89801-5072
US

IV. Provider business mailing address

PO BOX 426
ELKO NV
89803-0426
US

V. Phone/Fax

Practice location:
  • Phone: 916-712-7357
  • Fax: 866-305-6742
Mailing address:
  • Phone: 916-712-7357
  • Fax: 866-305-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number13000504
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number75598
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3100640
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH65893
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007776
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294981
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021139
License Number StateAZ
# 8
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19097
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: