Provider Demographics
NPI:1508130931
Name:BENNEFIELD, SYS DENNIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYS
Middle Name:DENNIS
Last Name:BENNEFIELD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRANDT CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4591
Mailing Address - Country:US
Mailing Address - Phone:520-979-0315
Mailing Address - Fax:
Practice Address - Street 1:79 HOLDER ROAD
Practice Address - Street 2:
Practice Address - City:LUMPKIN
Practice Address - State:GA
Practice Address - Zip Code:31815
Practice Address - Country:US
Practice Address - Phone:229-838-1266
Practice Address - Fax:229-838-1242
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9831183500000X
GA023585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist