Healthcare Provider Details

I. General information

NPI: 1255236576
Provider Name (Legal Business Name): BLAIR BENBOW PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INTERMOUNTAIN HEALTH LDS HOSPITAL
SALT LAKE CITY UT
84143-0001
US

IV. Provider business mailing address

1240 E STRINGHAM AVE APT 625
SALT LAKE CITY UT
84106-1024
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14293104-8911
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: