Provider Demographics
NPI:1265721369
Name:BENNETT, SONJA LEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:LEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 WEST 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620
Mailing Address - Country:US
Mailing Address - Phone:229-896-2300
Mailing Address - Fax:229-896-1350
Practice Address - Street 1:715 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2657
Practice Address - Country:US
Practice Address - Phone:229-896-2300
Practice Address - Fax:229-896-1350
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist