Provider Demographics
NPI:1598064560
Name:PEGRAM, BENJAMIN C (RPH)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:C
Last Name:PEGRAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 HILLSBORO RD STE 124
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-6236
Mailing Address - Country:US
Mailing Address - Phone:615-791-0394
Mailing Address - Fax:615-595-9458
Practice Address - Street 1:2176 HILLSBORO RD STE 124
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-6236
Practice Address - Country:US
Practice Address - Phone:615-791-0394
Practice Address - Fax:615-595-9458
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist