Provider Demographics
NPI:1508382086
Name:BENNETT, NICOLE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 N CASTLE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5602
Mailing Address - Country:US
Mailing Address - Phone:843-532-8852
Mailing Address - Fax:
Practice Address - Street 1:59 GEORGE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1422
Practice Address - Country:US
Practice Address - Phone:843-720-8523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist