MEDICARE: BENJAMIN MARTIN MCGINNIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03442117	OH
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	26030024A	IN
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	022996	KY

General Provider Information

NPI Number	:	1053045187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MARTIN MCGINNIS

Provider Business Mailing Address
First Line	:	1688 FIELDCREST DR
Second Line	:
City	:	LAWRENCEBURG
State	:	IN
Zip	:	47025-9379
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 DIXIE HWY
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-2902
Country	:	US
Telephone Number	:	859-331-0078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	05/21/2026

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