Provider Demographics
NPI:1265035216
Name:BENNETT-ANDREWS, THERESA C
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:C
Last Name:BENNETT-ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DELAMERE PL
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1729
Mailing Address - Country:US
Mailing Address - Phone:770-676-8080
Mailing Address - Fax:
Practice Address - Street 1:5421 NEW JESUP HWY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-1119
Practice Address - Country:US
Practice Address - Phone:912-264-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist