Provider Demographics
NPI:1619145810
Name:CRENSHAW, BENJAMIN RICHARD JR (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:RICHARD
Last Name:CRENSHAW
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9590 QUAIL RUN RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1733
Mailing Address - Country:US
Mailing Address - Phone:410-228-7608
Mailing Address - Fax:
Practice Address - Street 1:780 CAMBRIDGE PLZ
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2531
Practice Address - Country:US
Practice Address - Phone:410-228-7608
Practice Address - Fax:410-228-7329
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16138OtherPHARMACY LICENSE #