Provider Demographics
NPI:1255316899
Name:BENNETT, DENISE B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:B
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13202 CLEVELAND ST W STE 100
Mailing Address - Street 2:
Mailing Address - City:NAHUNTA
Mailing Address - State:GA
Mailing Address - Zip Code:31553-2842
Mailing Address - Country:US
Mailing Address - Phone:912-462-3784
Mailing Address - Fax:912-462-8040
Practice Address - Street 1:13202 CLEVELAND ST W STE 100
Practice Address - Street 2:
Practice Address - City:NAHUNTA
Practice Address - State:GA
Practice Address - Zip Code:31553-2842
Practice Address - Country:US
Practice Address - Phone:912-462-3784
Practice Address - Fax:912-462-8040
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist