Basic Information
| Provider Information | |||||||||
| NPI: | 1528677838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDRY | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 JARED RD | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040396802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077405578 | ||||||||
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| Practice Location | |||||||||
| Address1: | 76 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077952800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2020 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P2201X | PR46193 | ME | Y |
No ID Information.