Provider Demographics
NPI:1033713425
Name:REAGH, BENJAMIN KENNETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:KENNETH
Last Name:REAGH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 TUSCANY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5520
Mailing Address - Country:US
Mailing Address - Phone:386-290-3085
Mailing Address - Fax:
Practice Address - Street 1:2301 MOODY BLVD
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-4427
Practice Address - Country:US
Practice Address - Phone:386-439-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist