Provider Demographics
NPI:1548596463
Name:BENJAMIN, AMBER KRISTIN
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KRISTIN
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NE 3RD ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3854
Mailing Address - Country:US
Mailing Address - Phone:541-389-1717
Mailing Address - Fax:
Practice Address - Street 1:1900 NE 3RD ST
Practice Address - Street 2:SUITE 111
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3854
Practice Address - Country:US
Practice Address - Phone:541-389-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0013266OtherPHARMACIST