Provider Demographics
NPI:1861850901
Name:OVALLE, BENJAMIN OVALLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:OVALLE
Last Name:OVALLE
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 1:1309 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3342
Mailing Address - Country:US
Mailing Address - Phone:361-790-8706
Mailing Address - Fax:361-790-8967
Practice Address - Street 1:1309 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3342
Practice Address - Country:US
Practice Address - Phone:361-790-8706
Practice Address - Fax:361-790-8967
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist