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General NPI Number Information
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NPI Number | 1043594849
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Entity Type | Individual
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Provider Name | BENJAMIN ALEX PHELPS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 1300 14TH ST SW
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City | LOVELAND
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State | CO
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Zip | 80537-6780
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Country | US
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Telephone | 970-612-1125
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Fax | 970-612-1129
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Provider Business Mailing Address
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Address Line | 1300 14TH ST SW
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City | LOVELAND
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State | CO
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Zip | 80537-6780
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Country | US
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Telephone | 970-612-1125
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Fax | 970-612-1129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18393
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License Number State | CO
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