Provider Demographics
NPI:1306022215
Name:BEN-SAULL, ALLAN J (RPH)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:J
Last Name:BEN-SAULL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 E RALEIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-4907
Mailing Address - Country:US
Mailing Address - Phone:252-977-0066
Mailing Address - Fax:252-442-6250
Practice Address - Street 1:1123 E RALEIGH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-4907
Practice Address - Country:US
Practice Address - Phone:252-977-0066
Practice Address - Fax:252-442-6250
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35301183500000X
NC18769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01588903Medicaid