Provider Demographics
NPI:1104272954
Name:BENNETT, WILLIAM LUTHER (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LUTHER
Last Name:BENNETT
Suffix:
Gender:M
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:P.O. BOX 690486
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-0486
Mailing Address - Country:US
Mailing Address - Phone:209-955-1966
Mailing Address - Fax:209-487-5349
Practice Address - Street 1:1131 SUNNYOAK WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209
Practice Address - Country:US
Practice Address - Phone:209-955-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist