Provider Demographics
NPI:1891394292
Name:COLOSMO, BENJAMIN DANIEL
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:COLOSMO
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 1:1005 FAIRHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4638
Mailing Address - Country:US
Mailing Address - Phone:412-508-8049
Mailing Address - Fax:
Practice Address - Street 1:237 HANBURY RD E
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6621
Practice Address - Country:US
Practice Address - Phone:757-546-9376
Practice Address - Fax:757-546-9459
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist