Provider Demographics
NPI:1609419993
Name:FARWELL, BENJAMIN TROY
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TROY
Last Name:FARWELL
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 1:10119 OLD OCEAN CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1143
Mailing Address - Country:US
Mailing Address - Phone:410-629-0536
Mailing Address - Fax:
Practice Address - Street 1:10119 OLD OCEAN CITY BLVD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1143
Practice Address - Country:US
Practice Address - Phone:410-629-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-20
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist