Provider Demographics
NPI:1780058958
Name:BENSON, JUSTIN RICK (RPH)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RICK
Last Name:BENSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 W ELK HORN PEAK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6470
Mailing Address - Country:US
Mailing Address - Phone:801-808-6711
Mailing Address - Fax:
Practice Address - Street 1:5332 W ELK HORN PEAK DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6470
Practice Address - Country:US
Practice Address - Phone:801-808-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT354040-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist