Provider Demographics
NPI:1003337932
Name:FIEVISOHN, BENJAMIN H (RPH)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:H
Last Name:FIEVISOHN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 TORRANCE AVE
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1338
Mailing Address - Country:US
Mailing Address - Phone:518-578-0403
Mailing Address - Fax:
Practice Address - Street 1:85 ROBINSON AT
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901
Practice Address - Country:US
Practice Address - Phone:607-722-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist