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General NPI Number Information
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NPI Number | 1821310186
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Entity Type | Individual
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Provider Name | JOHN ROBERT BENEDICT PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 2309 N TRIPHAMMER RD
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City | ITHACA
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State | NY
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Zip | 14850-1060
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Country | US
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Telephone | 607-257-2011
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Fax | 607-266-0943
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Provider Business Mailing Address
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Address Line | 300 HALSEYVILLE RD
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City | ITHACA
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State | NY
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Zip | 14850-9232
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Country | US
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Telephone | 607-869-5033
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Fax | 607-869-5033
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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 | 053697
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License Number State | NY
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