Provider Demographics
NPI:1992087886
Name:BENNETT, MAUREEN DONNELLY (RPH)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:DONNELLY
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 1:8345 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1385
Mailing Address - Country:US
Mailing Address - Phone:919-484-4191
Mailing Address - Fax:919-484-4100
Practice Address - Street 1:8345 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1385
Practice Address - Country:US
Practice Address - Phone:919-484-4191
Practice Address - Fax:919-484-4100
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist