Provider Demographics
NPI:1295027902
Name:LE, BENJAMIN (RPH, BCPS, REHS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:RPH, BCPS, REHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-0426
Mailing Address - Country:US
Mailing Address - Phone:916-712-7357
Mailing Address - Fax:866-305-6742
Practice Address - Street 1:515 SHOSHONE CIR
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-5072
Practice Address - Country:US
Practice Address - Phone:916-712-7357
Practice Address - Fax:866-305-6742
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH65893183500000X
NM13000504146N00000X
NV75598146N00000X
NVE3100640146N00000X
NMRP00007776183500000X
IL051.294981183500000X
AZS021139183500000X
NV19097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV19097OtherSTATE LICENSURE