Provider Demographics
NPI:1871908061
Name:TUBERT, BENJAMIN MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:TUBERT
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 1:4 CENTRAL PLZ
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 CENTRAL PLZ
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1701
Practice Address - Country:US
Practice Address - Phone:315-894-9995
Practice Address - Fax:315-894-9481
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist