| Doctor Name: | MRS. CAROL HENSHAW WALLACE |
| NPI Number: | 1104107838 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHARMACIST |
| License Number: | 8424 |
| Business Practice Address: | 1201 Dinah Shore Boulevard Bennetts Pharmacy Winchester, TN - 37398 |
| Business Phone Number: | 9319672777 |
| Business Fax Number: | 9319671264 |
| Mailing Address: | Po Box 70, Bennetts Pharmacy WINCHESTER |
| State: | TN |
| Postal Code: | 37398 |
| Phone Number: | 9319672777 |
| Fax Number: | 9319671264 |
| NPI Enumeration Date: | 09/08/2011 |
| NPI Last Update Date: | 06/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 8424 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |