Provider Demographics
NPI:1679398911
Name:KISER, BENJAMIN ROSS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ROSS
Last Name:KISER
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:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-0446
Mailing Address - Country:US
Mailing Address - Phone:336-414-6186
Mailing Address - Fax:336-983-2933
Practice Address - Street 1:533 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021
Practice Address - Country:US
Practice Address - Phone:336-983-3118
Practice Address - Fax:336-983-2933
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist