Provider Demographics
NPI:1255794822
Name:BENNETT, JUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:BENNETT
Suffix:
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 1:120 N 27TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3286
Mailing Address - Country:US
Mailing Address - Phone:402-371-3444
Mailing Address - Fax:402-371-3566
Practice Address - Street 1:120 N 27TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3286
Practice Address - Country:US
Practice Address - Phone:402-371-3444
Practice Address - Fax:402-371-3566
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13366183500000X
NE13748183500000X
NV18489183500000X
MN121145183500000X
KS1-15582183500000X
CO20182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist