Provider Demographics
NPI:1821310186
Name:BENEDICT, JOHN ROBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:BENEDICT
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 1:300 HALSEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9232
Mailing Address - Country:US
Mailing Address - Phone:607-869-5033
Mailing Address - Fax:607-869-5033
Practice Address - Street 1:2309 N TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1060
Practice Address - Country:US
Practice Address - Phone:607-257-2011
Practice Address - Fax:607-266-0943
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist