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NPI Code Detail

MEDICARE: DR. BENJAMIN F FOMINYAM PHARM.D / MBA

MEDICARE: DR. BENJAMIN F FOMINYAM PHARM.D / MBA
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
1183500000XPharmacistS020076AZ

General Provider Information

NPI Number : 1922409796
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN F FOMINYAM PHARM.D / MBA
Provider Business Mailing Address
First Line : 16778 W APACHE ST
Second Line :
City : GOODYEAR
State : AZ
Zip : 85338-7433
Country : US
Telephone Number : 702-427-3000
Fax Number :
Provider Business Practice Location Address
First Line : 8325 W INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85037-2125
Country : US
Telephone Number : 623-245-7353
Fax Number : 623-245-7347
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2014
Last Update Date : 08/21/2015

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