Provider Demographics
NPI:1437418480
Name:GREATHOUSE, BENJAMIN MARTIN (PHARMD CANDIDATE)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:MARTIN
Last Name:GREATHOUSE
Suffix:
Gender:M
Credentials:PHARMD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 N CEDAR ST.
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2240 N CEDAR ST.
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48854-1201
Practice Address - Country:US
Practice Address - Phone:517-694-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist