Provider Demographics
NPI:1346665106
Name:NEWMAN, BENJI (RPH)
Entity Type:Individual
Prefix:
First Name:BENJI
Middle Name:
Last Name:NEWMAN
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 1:316 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1916
Mailing Address - Country:US
Mailing Address - Phone:312-791-0461
Mailing Address - Fax:
Practice Address - Street 1:316 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1916
Practice Address - Country:US
Practice Address - Phone:312-791-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296480183500000X
LAPST.020426183500000X
GARPH020101183500000X
AL13591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.296480OtherSTATE LICENSE NUMBER
GARPH020101OtherSTATE LICENSE NUMBER
AL13591OtherSTATE LICENSE NUMBER
LAPST.020426OtherSTATE LICENSE NUMBER