Provider Demographics
NPI:1831481837
Name:BENNETT, JEFFREY A
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5635
Mailing Address - Country:US
Mailing Address - Phone:919-772-0767
Mailing Address - Fax:919-772-9809
Practice Address - Street 1:8101 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-5635
Practice Address - Country:US
Practice Address - Phone:919-772-0767
Practice Address - Fax:919-772-9809
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist