Provider Demographics
NPI:1306225651
Name:BENZER, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BENZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 NORTHLAND DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9256
Mailing Address - Country:US
Mailing Address - Phone:616-685-8375
Mailing Address - Fax:
Practice Address - Street 1:6050 NORTHLAND DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9256
Practice Address - Country:US
Practice Address - Phone:616-685-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020387341835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist