Provider Demographics
NPI:1891000519
Name:BLANKINCHIP, BENJAMIN PRESTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:PRESTON
Last Name:BLANKINCHIP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BENNIE
Other - Middle Name:PRESTON
Other - Last Name:BLANKINCHIP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12230 LOTT RD
Mailing Address - Street 2:
Mailing Address - City:CHUNCHULA
Mailing Address - State:AL
Mailing Address - Zip Code:36521-3350
Mailing Address - Country:US
Mailing Address - Phone:251-866-0224
Mailing Address - Fax:
Practice Address - Street 1:4739 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36613-3512
Practice Address - Country:US
Practice Address - Phone:251-457-6666
Practice Address - Fax:251-330-3206
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist