Provider Demographics
NPI:1740909175
Name:TROUT, BENJAMIN (PHARMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:TROUT
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 1:5000 N MAYS ST APT 1322
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2684
Mailing Address - Country:US
Mailing Address - Phone:573-625-1517
Mailing Address - Fax:
Practice Address - Street 1:301 CHRIS KELLEY BLVD
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5088
Practice Address - Country:US
Practice Address - Phone:512-846-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist