Provider Demographics
NPI:1972714616
Name:MAHARREY, BENNIE EDWARD III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENNIE
Middle Name:EDWARD
Last Name:MAHARREY
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MEDICINE BEND DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7652
Mailing Address - Country:US
Mailing Address - Phone:256-361-5627
Mailing Address - Fax:256-828-1088
Practice Address - Street 1:12290 HIGHWAY 231 431 N
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-1200
Practice Address - Country:US
Practice Address - Phone:256-828-1000
Practice Address - Fax:256-828-1088
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist