Provider Demographics
NPI:1821867227
Name:SAND, BENJAMIN
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:SAND
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 1:206 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-2702
Mailing Address - Country:US
Mailing Address - Phone:662-728-1951
Mailing Address - Fax:662-728-1873
Practice Address - Street 1:206 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2702
Practice Address - Country:US
Practice Address - Phone:662-728-1951
Practice Address - Fax:662-728-1873
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE16088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist