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NPI Code Detail

MEDICARE: MR. BENJAMIN SHANE WILLIMAN RPH

MEDICARE: MR. BENJAMIN SHANE WILLIMAN RPH
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
1183500000XPharmacist16704NC

General Provider Information

NPI Number : 1851693626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENJAMIN SHANE WILLIMAN RPH
Provider Business Mailing Address
First Line : 1371 E BROAD ST
Second Line :
City : FUQUAY VARINA
State : NC
Zip : 27526-1966
Country : US
Telephone Number : 919-567-7426
Fax Number :
Provider Business Practice Location Address
First Line : 1371 E BROAD ST
Second Line :
City : FUQUAY VARINA
State : NC
Zip : 27526-1966
Country : US
Telephone Number : 919-567-7426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2010
Last Update Date : 11/29/2010

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