MEDICARE: WENDE BENSON

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	183500000X	Pharmacist	PH00017623	WA

General Provider Information

NPI Number	:	1609309616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDE BENSON

Provider Business Mailing Address
First Line	:	PO BOX 995
Second Line	:
City	:	ABERDEEN
State	:	WA
Zip	:	98520-0205
Country	:	US
Telephone Number	:	425-314-8879
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 N BROADWAY ST
Second Line	:
City	:	ABERDEEN
State	:	WA
Zip	:	98520-3934
Country	:	US
Telephone Number	:	425-314-8879
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/06/2017

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Directions to “ WENDE BENSON ” Practice Location

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