Provider Demographics
NPI:1710295340
Name:MICHAELS, BENJAMIN ROBERT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:MICHAELS
Suffix:
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 1:3800 SE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-797-3661
Mailing Address - Fax:503-797-3960
Practice Address - Street 1:3800 SE 22ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2918
Practice Address - Country:US
Practice Address - Phone:503-797-3661
Practice Address - Fax:503-797-3960
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230522183500000X
OR0012403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist