Provider Demographics
NPI:1750726642
Name:FLECK, BENJAMIN ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:FLECK
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 1:3887 MAIDENS LARNE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5823
Mailing Address - Country:US
Mailing Address - Phone:614-404-5303
Mailing Address - Fax:
Practice Address - Street 1:3887 MAIDENS LARNE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-5823
Practice Address - Country:US
Practice Address - Phone:614-404-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124614-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist