Provider Demographics
NPI:1003026360
Name:BENSON, SHELLEY GRACE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:GRACE
Last Name:BENSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05061-9748
Mailing Address - Country:US
Mailing Address - Phone:802-728-6382
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31771835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology