Provider Demographics
NPI:1518238864
Name:BENJAMIN, VICTORIA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W BANNISTER RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4010
Mailing Address - Country:US
Mailing Address - Phone:847-224-2766
Mailing Address - Fax:
Practice Address - Street 1:9430 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-3846
Practice Address - Country:US
Practice Address - Phone:816-765-5279
Practice Address - Fax:816-765-5879
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist