Individual
LUNAWATI LO BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 UNION UNIVERSITY DR, JACKSON, TN 38305-3697
(561) 420-9471
Mailing address
1050 UNION UNIVERSITY DR, JACKSON, TN 38305-3697
(561) 420-9471
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0000036711
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHARMACIST
PHARMACIST
TN
Enumeration date
11/03/2020
Last updated
11/03/2020
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