Healthcare Provider Details

I. General information

NPI: 1376838920
Provider Name (Legal Business Name): JAMAELA BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2011
Last Update Date: 06/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 BRANDYWINE PKWY T1146
WILMINGTON DE
19803-1492
US

IV. Provider business mailing address

1050 BRANDYWINE PKWY T1146
WILMINGTON DE
19803-1492
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-3200
  • Fax: 302-478-3200
Mailing address:
  • Phone: 302-478-3200
  • Fax: 302-478-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003323
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: