Provider Demographics
NPI:1659625663
Name:FRITCHMAN, BENJAMIN WOODROW
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WOODROW
Last Name:FRITCHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:FRITCHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1535 7TH AVE S APT 219
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-8916
Mailing Address - Country:US
Mailing Address - Phone:320-533-0205
Mailing Address - Fax:
Practice Address - Street 1:645 LAKE ST S
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1545
Practice Address - Country:US
Practice Address - Phone:320-732-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist