Provider Demographics
NPI:1770225682
Name:BENIG, KRISTIAN TEODY BUENCONSEJO (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIAN TEODY
Middle Name:BUENCONSEJO
Last Name:BENIG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 162ND ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1541
Mailing Address - Country:US
Mailing Address - Phone:708-441-9336
Mailing Address - Fax:
Practice Address - Street 1:9554 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1892
Practice Address - Country:US
Practice Address - Phone:815-806-0438
Practice Address - Fax:815-806-9154
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0513044411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist