Provider Demographics
NPI:1720293400
Name:MYATT, BENJAMIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:MYATT
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 1:4701 TROUSDALE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1320
Mailing Address - Country:US
Mailing Address - Phone:615-832-7232
Mailing Address - Fax:615-331-6673
Practice Address - Street 1:4701 TROUSDALE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1320
Practice Address - Country:US
Practice Address - Phone:615-832-7232
Practice Address - Fax:615-331-6673
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35575183500000X
AL15667183500000X
VA0202211331183500000X
LA020062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist