Provider Demographics
NPI:1740885086
Name:BENNAM, POWUM (PHARMD)
Entity type:Individual
Prefix:
First Name:POWUM
Middle Name:
Last Name:BENNAM
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 1:9555 KINGS CHARTER DR STE D
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7994
Mailing Address - Country:US
Mailing Address - Phone:800-753-0596
Mailing Address - Fax:804-799-7917
Practice Address - Street 1:16793 CAPON TREE LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5134
Practice Address - Country:US
Practice Address - Phone:571-481-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty