Provider Demographics
NPI:1346535101
Name:BENSON, ANDREA NEILL (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NEILL
Last Name:BENSON
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 1:135 LOUMAE RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-5137
Mailing Address - Country:US
Mailing Address - Phone:678-688-5588
Mailing Address - Fax:770-228-2307
Practice Address - Street 1:1475 N EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1776
Practice Address - Country:US
Practice Address - Phone:770-228-4426
Practice Address - Fax:770-228-2307
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist