Provider Demographics
NPI:1700252475
Name:FRIETSCH, BENJAMIN (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:FRIETSCH
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 N NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1772
Mailing Address - Country:US
Mailing Address - Phone:309-256-3417
Mailing Address - Fax:
Practice Address - Street 1:107 TREMONT ST
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:IL
Practice Address - Zip Code:61747
Practice Address - Country:US
Practice Address - Phone:309-449-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist