Provider Demographics
NPI:1215559620
Name:BENSON, MOLLY HEATHER O'BRIEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:HEATHER O'BRIEN
Last Name:BENSON
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 1:2260 JFK RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2881
Mailing Address - Country:US
Mailing Address - Phone:563-582-1659
Mailing Address - Fax:
Practice Address - Street 1:2260 JFK RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2881
Practice Address - Country:US
Practice Address - Phone:563-582-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist