Provider Demographics
NPI:1518550375
Name:SANDECKI, BENJAMIN CLAYTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CLAYTON
Last Name:SANDECKI
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 1:3116 NW 65TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3510
Mailing Address - Country:US
Mailing Address - Phone:918-704-1777
Mailing Address - Fax:
Practice Address - Street 1:328 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-6607
Practice Address - Country:US
Practice Address - Phone:580-336-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist