Healthcare Provider Details

I. General information

NPI: 1780058958
Provider Name (Legal Business Name): JUSTIN RICK BENSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5332 W ELK HORN PEAK DR
RIVERTON UT
84096-6470
US

IV. Provider business mailing address

5332 W ELK HORN PEAK DR
RIVERTON UT
84096-6470
US

V. Phone/Fax

Practice location:
  • Phone: 801-808-6711
  • Fax:
Mailing address:
  • Phone: 801-808-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number354040-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: