Provider Demographics
NPI:1245572098
Name:ALLEN, BENJAMIN REID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:REID
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13028 TONKEL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9226
Mailing Address - Country:US
Mailing Address - Phone:260-403-8855
Mailing Address - Fax:
Practice Address - Street 1:1542 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-1708
Practice Address - Country:US
Practice Address - Phone:937-254-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132508183500000X
IN26024904A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist