Provider Demographics
NPI:1659748291
Name:BENNETT, SADIE MANNINO (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:SADIE
Middle Name:MANNINO
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3232
Mailing Address - Country:US
Mailing Address - Phone:985-542-8466
Mailing Address - Fax:985-542-2561
Practice Address - Street 1:113 W CHARLES ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3232
Practice Address - Country:US
Practice Address - Phone:985-542-8466
Practice Address - Fax:985-542-2561
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2399411Medicaid