Provider Demographics
NPI:1528375326
Name:VAVRA, BENJAMIN RYAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RYAN
Last Name:VAVRA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 AMES AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2149
Mailing Address - Country:US
Mailing Address - Phone:307-640-1048
Mailing Address - Fax:
Practice Address - Street 1:4310 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2149
Practice Address - Country:US
Practice Address - Phone:307-640-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3175183500000X
CA68880183500000X
NE15014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist