Provider Demographics
NPI:1073898961
Name:BENJAMIN, MICHELLE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E MCLELLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1237
Mailing Address - Country:US
Mailing Address - Phone:602-421-8591
Mailing Address - Fax:
Practice Address - Street 1:387 N ESTRELLA PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9298
Practice Address - Country:US
Practice Address - Phone:623-215-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist