Provider Demographics
NPI:1376079699
Name:VANBENSCHOTEN, ANNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:VANBENSCHOTEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 25TH ST NE
Mailing Address - Street 2:APT 6034
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3991
Mailing Address - Country:US
Mailing Address - Phone:423-458-8408
Mailing Address - Fax:
Practice Address - Street 1:300 25TH ST NE
Practice Address - Street 2:APT 6034
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3991
Practice Address - Country:US
Practice Address - Phone:423-458-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40296183500000X
VA0202208429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist