Provider Demographics
NPI:1679650881
Name:BENNETT, JILL R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:R
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 MCLEAN DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-3091
Mailing Address - Country:US
Mailing Address - Phone:608-230-6408
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF WISCONSIN HOSPITAL
Practice Address - Street 2:600 HIGHLAND AVE F6/133-1530
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-263-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137111835P1200X
IA197701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy