Provider Demographics
NPI:1801204391
Name:SEAGREN, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SEAGREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5985 PEACHTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2818
Mailing Address - Country:US
Mailing Address - Phone:678-421-9599
Mailing Address - Fax:678-421-0364
Practice Address - Street 1:5985 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2818
Practice Address - Country:US
Practice Address - Phone:678-421-9599
Practice Address - Fax:678-421-0364
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.297580183500000X
GARPH031894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist