Provider Demographics
NPI:1174011720
Name:SCHORTGEN, BENJAMIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SCHORTGEN
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 1:1025 PLEASANT PT
Mailing Address - Street 2:
Mailing Address - City:ROME CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46784-9646
Mailing Address - Country:US
Mailing Address - Phone:260-705-2107
Mailing Address - Fax:
Practice Address - Street 1:1900 CAREW ST STE 4
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4765
Practice Address - Country:US
Practice Address - Phone:260-373-9775
Practice Address - Fax:260-373-9789
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022774A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist