Provider Demographics
NPI:1417656208
Name:BENNETHUM, LINDSAY KOHLER (PHARMD, BCOP, CPP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:KOHLER
Last Name:BENNETHUM
Suffix:
Gender:F
Credentials:PHARMD, BCOP, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11991 MCBRIDE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8338
Mailing Address - Country:US
Mailing Address - Phone:434-825-2124
Mailing Address - Fax:
Practice Address - Street 1:460 WATERSTONE DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9078
Practice Address - Country:US
Practice Address - Phone:984-215-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC305491835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology