Provider Demographics
NPI:1346836079
Name:EHRICHS, BENJAMEN BRYAN
Entity Type:Individual
Prefix:
First Name:BENJAMEN
Middle Name:BRYAN
Last Name:EHRICHS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WESTWOOD ST APT 120
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6290
Mailing Address - Country:US
Mailing Address - Phone:701-367-3129
Mailing Address - Fax:
Practice Address - Street 1:1101 WESTWOOD ST APT 120
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6290
Practice Address - Country:US
Practice Address - Phone:701-367-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist