Provider Demographics
NPI:1164702791
Name:COLWELL, BENJAMIN EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:COLWELL
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 1:2001 5TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-2916
Mailing Address - Country:US
Mailing Address - Phone:309-792-1531
Mailing Address - Fax:309-792-1518
Practice Address - Street 1:2001 5TH ST STE 1
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2916
Practice Address - Country:US
Practice Address - Phone:309-792-1531
Practice Address - Fax:309-792-1518
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21262183500000X
IL051.294397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist