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General NPI Number Information
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NPI Number | 1770225682
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Entity Type | Individual
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Provider Name | KRISTIAN TEODY BUENCONSEJO BENIG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 9554 E LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1892
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Country | US
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Telephone | 815-806-0438
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Fax | 815-806-9154
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Provider Business Mailing Address
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Address Line | 7512 162ND ST
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City | TINLEY PARK
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State | IL
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Zip | 60477-1541
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Country | US
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Telephone | 708-441-9336
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Fax |
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 051304441
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License Number State | IL
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