Active NPI
Benjamin F Fominyam, PHARM.D / MBA
- Pharmacist
- Phoenix, AZ
National Provider Identifier
1922409796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S020076
- Practice address
- 8325 W Indian School Rd
Phoenix, AZ 85037-2125 - Phone
- (623) 245-7353
- Fax
- (623) 245-7347
- NPI assigned
- Sep 10, 2014
- 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 | S020076 | AZ | Primary |
Addresses
Primary practice location
8325 W Indian School Rd
Phoenix, AZ 85037-2125
Mailing address
16778 W Apache St
Goodyear, AZ 85338-7433
Phone (702) 427-3000
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
- Credentials
- Master of Business Administration, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S020076 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smith'S Food & Drug Centers Inc | Past | Accepting new patients | |
| Smiths Food & Drug Centers Inc | 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.
-
- Community/Retail Pharmacy
- Phoenix, AZ
- NPI 1003858531
-
- Community/Retail Pharmacy
- Henderson, NV
- NPI 1881585248
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440115200000",
"number": "1922409796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16778 W APACHE ST",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853387433",
"telephone_number": "702-427-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8325 W INDIAN SCHOOL RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850372125",
"telephone_number": "623-245-7353",
"fax_number": "623-245-7347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMINYAM",
"first_name": "BENJAMIN",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "PHARM.D / MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-10",
"last_updated": "2015-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S020076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.