Organization Name: | BENNETT'S HOMETOWN PHARMACY, LLC-FOLKSTON |
NPI Number: | 1972819936 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DENISE BENNETT (OWNER/PHARMACIST) |
Mailing Address: | 4402 Second St N Folkston |
State: | GA US |
Postal Code: | 315379383 |
Phone Number: | 9124963784 |
Fax Number: | |
NPI Enumeration Date: | 08/27/2010 |
NPI Last Update Date: | 08/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | PHRE009663 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |