Provider Demographics
NPI:1619388295
Name:BENHAM, STACEY WUTHRICH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:WUTHRICH
Last Name:BENHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4077
Mailing Address - Country:US
Mailing Address - Phone:830-627-0069
Mailing Address - Fax:830-627-0093
Practice Address - Street 1:631 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4077
Practice Address - Country:US
Practice Address - Phone:830-627-0069
Practice Address - Fax:830-627-0093
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336361835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric