NPIMap

Organization Active NPI

Bennett's Hometown Pharmacy, LLC

  • Community/Retail Pharmacy
  • Nahunta, GA
National Provider Identifier
1902963648
Registry record updated May 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE008878 Issued in GA
Legal business name
BENNETT'S HOMETOWN PHARMACY, LLC
Practice address
13202 Cleveland St W Ste 100
Nahunta, GA 31553-2842
Phone
(912) 462-3784
Fax
(912) 462-8040
NPI assigned
Jan 2, 2007
Last updated
May 12, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Denise B Bennett, R.PH.NPI 1255316899
Title
Owner
Phone
(912) 462-3784

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X PHRE008878 GA Primary

Addresses

Primary practice location

13202 Cleveland St W Ste 100
Nahunta, GA 31553-2842

Mailing address

13202 Cleveland St W Ste 100
Nahunta, GA 31553-2842
Phone (912) 462-3784

Other identifiers 2

IdentifierTypeStateIssuer
735642371BMedicaidGA
735642371AMedicaidGA

National Provider Directory

National Provider Directory

Locations

13202 Cleveland St W
Nahunta, GA 31553
Phone (912) 462-3784

13202 Cleveland St W
Ste 100
Nahunta, GA 31553
Phone (912) 462-3784

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242086400000",
    "number": "1902963648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13202 CLEVELAND ST W STE 100",
            "city": "NAHUNTA",
            "state": "GA",
            "postal_code": "315532842",
            "telephone_number": "912-462-3784",
            "fax_number": "912-462-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13202 CLEVELAND ST W STE 100",
            "city": "NAHUNTA",
            "state": "GA",
            "postal_code": "315532842",
            "telephone_number": "912-462-3784",
            "fax_number": "912-462-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT'S HOMETOWN PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2009-05-12",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-462-3784",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE008878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "735642371B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "735642371A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nahunta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.