Individual
BENJAMIN ISAAC NIEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1106 W CLAIREMONT AVE, EAU CLAIRE, WI 54701-6124
(715) 852-0063
Mailing address
2402 RIDGEVIEW DR, APT. 302, EAU CLAIRE, WI 54701-7853
(763) 242-3476
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15998-040
WI
Other
Enumeration date
10/26/2011
Last updated
10/26/2011
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