Provider Demographics
NPI:1982181970
Name:BENN, MATTHEW ELGIN (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ELGIN
Last Name:BENN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 OLD NASHUA RD UNIT 55
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3656
Mailing Address - Country:US
Mailing Address - Phone:254-415-8788
Mailing Address - Fax:
Practice Address - Street 1:105 MILTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03868-8604
Practice Address - Country:US
Practice Address - Phone:603-335-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-04444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist