Provider Demographics
NPI:1770805624
Name:BENNETT, CAROL P (RPH)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:P
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 HIGHWAY 320
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-5196
Mailing Address - Country:US
Mailing Address - Phone:706-886-9215
Mailing Address - Fax:
Practice Address - Street 1:8040 HIGHWAY 320
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-5196
Practice Address - Country:US
Practice Address - Phone:706-886-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist