Individual
BENJAMIN GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
3345 GLADE CREEK BLVD NE APT 12, ROANOKE, VA 24012-8620
(715) 409-0437
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202219693
VA
183500000X
Pharmacist
30488
NC
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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