Provider Demographics
NPI:1518265263
Name:BENNETT, STEPHEN DODSON III (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DODSON
Last Name:BENNETT
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1619
Mailing Address - Country:US
Mailing Address - Phone:252-243-3131
Mailing Address - Fax:252-243-5431
Practice Address - Street 1:2650 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1619
Practice Address - Country:US
Practice Address - Phone:252-243-3131
Practice Address - Fax:252-243-5431
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist