Healthcare Provider Details

I. General information

NPI: 1821828278
Provider Name (Legal Business Name): BENJAMIN JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 HAYMAKER RD
MONROEVILLE PA
15146-3513
US

IV. Provider business mailing address

2204 STONECLIFFE DR
MONROEVILLE PA
15146-3213
US

V. Phone/Fax

Practice location:
  • Phone: 412-858-2000
  • Fax:
Mailing address:
  • Phone: 412-694-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP458634
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: