Provider Demographics
NPI:1467052860
Name:MCCALIB, BENJAMIN WADE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WADE
Last Name:MCCALIB
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 1:3010 W LOOP 1604 N APT 2308
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3908
Mailing Address - Country:US
Mailing Address - Phone:281-546-9707
Mailing Address - Fax:
Practice Address - Street 1:11210 POTRANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5844
Practice Address - Country:US
Practice Address - Phone:210-679-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist