Provider Demographics
NPI:1083250138
Name:NYBOER, BENJAMIN T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:T
Last Name:NYBOER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:NYBOER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4461 HICKORY RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7455
Mailing Address - Country:US
Mailing Address - Phone:812-219-6505
Mailing Address - Fax:
Practice Address - Street 1:4461 HICKORY RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7455
Practice Address - Country:US
Practice Address - Phone:860-907-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024541A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty