Provider Demographics
NPI:1194004580
Name:EGELAND, BENJAMIN ROBERT (CPHT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:EGELAND
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5233
Mailing Address - Country:US
Mailing Address - Phone:402-965-8800
Mailing Address - Fax:866-632-7946
Practice Address - Street 1:13660 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5233
Practice Address - Country:US
Practice Address - Phone:402-965-8800
Practice Address - Fax:866-632-7946
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1260183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician