Provider Demographics
NPI:1881754018
Name:BENNETT DRUG COMPANY
Entity type:Organization
Organization Name:BENNETT DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-468-7479
Mailing Address - Street 1:207 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-1540
Mailing Address - Country:US
Mailing Address - Phone:229-468-7478
Mailing Address - Fax:229-468-7479
Practice Address - Street 1:207 E 4TH ST
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-1540
Practice Address - Country:US
Practice Address - Phone:229-468-7478
Practice Address - Fax:229-468-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0054093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1112767OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA000021887AMedicaid