Active NPI
Robert O Benjamin
- Pharmacist
- Lake Dallas, TX
National Provider Identifier
1659693455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 048050
- Practice address
- 616 Lake Bridge Dr
Lake Dallas, TX 75065-2887 - Phone
- (940) 808-2706
- NPI assigned
- Feb 19, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 048050 | NY | Primary |
Addresses
Primary practice location
616 Lake Bridge Dr
Lake Dallas, TX 75065-2887
Mailing address
616 Lake Bridge Dr
Lake Dallas, TX 75065-2887
Phone (940) 808-2706
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048050 | Other | NY | NEW YORK STATE PHARMACIST'S LICENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048050 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Pharmacy
- Auburn, NY
- NPI 1942215025
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615334400000",
"number": "1659693455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "616 LAKE BRIDGE DR",
"city": "LAKE DALLAS",
"state": "TX",
"postal_code": "750652887",
"telephone_number": "940-808-2706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "616 LAKE BRIDGE DR",
"city": "LAKE DALLAS",
"state": "TX",
"postal_code": "750652887",
"telephone_number": "940-808-2706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENJAMIN",
"first_name": "ROBERT",
"middle_name": "O",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-19",
"last_updated": "2021-03-10",
"certification_date": "2021-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "048050",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE PHARMACIST'S LICENCE",
"identifier": "048050",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.