Organization
BENNETTS HOMETOWN PHARMACY- BLACKSHEAR LLC
Active
Other names
Pierce Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE BENNETT (OWNER,PHARMACIST)
(912) 286-3784
Entity
Organization
Contact information
Practice address
3150 US HIGHWAY 84, BLACKSHEAR, GA 31516-4944
(912) 449-1400
Mailing address
PO BOX 864, BLACKSHEAR, GA 31516-0864
(912) 286-3784
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
391060474A
—
GA
Enumeration date
10/11/2018
Last updated
10/11/2018
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