Healthcare Provider Details

I. General information

NPI: 1629821855
Provider Name (Legal Business Name): BENJAMIN JACOB DEIKE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-358-8698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72627
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1835S0206X
TaxonomySolid Organ Transplant Pharmacist
License Number0202222850
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: