Provider Demographics
NPI:1043594849
Name:PHELPS, BENJAMIN ALEX (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ALEX
Last Name:PHELPS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 14TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-6780
Mailing Address - Country:US
Mailing Address - Phone:970-612-1125
Mailing Address - Fax:970-612-1129
Practice Address - Street 1:1300 14TH ST SW
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-6780
Practice Address - Country:US
Practice Address - Phone:970-612-1125
Practice Address - Fax:970-612-1129
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist