Organization
BENNETT'S HOMETOWN PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE B BENNETT R.PH. (OWNER)
(912) 462-3784
Entity
Organization
Contact information
Practice address
13202 CLEVELAND ST W STE 100, NAHUNTA, GA 31553-2842
(912) 462-3784
(912) 462-8040
Mailing address
13202 CLEVELAND ST W STE 100, NAHUNTA, GA 31553-2842
(912) 462-3784
(912) 462-8040
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE008878
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
735642371A
—
GA
05
—
735642371B
—
GA
Enumeration date
01/02/2007
Last updated
05/12/2009
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