Provider Demographics
NPI:1518557834
Name:WEINSTEIN, BENJAMIN LOUIS
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LOUIS
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HUTTLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1958
Mailing Address - Country:US
Mailing Address - Phone:508-993-7498
Mailing Address - Fax:
Practice Address - Street 1:220 HUTTLESTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-1958
Practice Address - Country:US
Practice Address - Phone:508-993-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH2343181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty