Provider Demographics
NPI:1053751784
Name:WASHAM, BENJAMIN BRENT (PHARMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BRENT
Last Name:WASHAM
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 1:992 LINKS DR APT 8
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-0791
Mailing Address - Country:US
Mailing Address - Phone:501-472-4691
Mailing Address - Fax:
Practice Address - Street 1:992 LINKS DR APT 8
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-0791
Practice Address - Country:US
Practice Address - Phone:501-472-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist