Provider Demographics
NPI:1336356997
Name:BENHAM, JAMES DONIS (PHARM B)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONIS
Last Name:BENHAM
Suffix:
Gender:M
Credentials:PHARM B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 LEE ROAD 435
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-4571
Mailing Address - Country:US
Mailing Address - Phone:334-297-9624
Mailing Address - Fax:
Practice Address - Street 1:700 CENTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1546
Practice Address - Country:US
Practice Address - Phone:706-660-2600
Practice Address - Fax:706-571-1706
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA013735OtherSTATE LICENSE NUMBER