Provider Demographics
NPI:1508921263
Name:NG, BENJAMIN K (RPH)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:K
Last Name:NG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1621
Mailing Address - Country:US
Mailing Address - Phone:773-561-1280
Mailing Address - Fax:773-561-8025
Practice Address - Street 1:4345 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1621
Practice Address - Country:US
Practice Address - Phone:773-561-1280
Practice Address - Fax:773-561-8025
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363805221001Medicaid
0964240001Medicare ID - Type Unspecified