Healthcare Provider Details

I. General information

NPI: 1134656754
Provider Name (Legal Business Name): BENJAMIN PAUL SMITH PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2017
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

3462 STERNS RD
LAMBERTVILLE MI
48144-9576
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-5418
  • Fax: 419-479-6927
Mailing address:
  • Phone: 734-854-2690
  • Fax: 734-854-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302034062
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03225276
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: