Provider Demographics
NPI:1164434999
Name:FLANAGAN, BENNIE C (RPH)
Entity Type:Individual
Prefix:
First Name:BENNIE
Middle Name:C
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5220
Mailing Address - Country:US
Mailing Address - Phone:770-974-7681
Mailing Address - Fax:770-975-9735
Practice Address - Street 1:4797 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5339
Practice Address - Country:US
Practice Address - Phone:770-974-3131
Practice Address - Fax:770-975-9735
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist