Provider Demographics
NPI:1447775978
Name:HARRIETHA, BENJAMIN JACOB (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JACOB
Last Name:HARRIETHA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MALIBU DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1366
Mailing Address - Country:US
Mailing Address - Phone:360-268-4438
Mailing Address - Fax:
Practice Address - Street 1:700 SLEATER KINNEY RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1150
Practice Address - Country:US
Practice Address - Phone:360-438-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2017-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60756301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist