Provider Demographics
NPI:1265031132
Name:BOLDING, BENJAMIN JANG (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JANG
Last Name:BOLDING
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 CLEARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-2855
Mailing Address - Country:US
Mailing Address - Phone:214-284-1983
Mailing Address - Fax:
Practice Address - Street 1:1312 14TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6206
Practice Address - Country:US
Practice Address - Phone:469-596-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist