Provider Demographics
NPI:1497010763
Name:MUDD, BENJAMIN PATRICK (PHARM D, RPH)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PATRICK
Last Name:MUDD
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 C MICHAEL DAVENPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4333
Mailing Address - Country:US
Mailing Address - Phone:270-699-6996
Mailing Address - Fax:
Practice Address - Street 1:96 C MICHAEL DAVENPORT BLVD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4333
Practice Address - Country:US
Practice Address - Phone:270-699-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist