MEDICARE: CASSANDRA BENNETT PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS55131	FL

General Provider Information

NPI Number	:	1053868414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA BENNETT PHARMD

Provider Business Mailing Address
First Line	:	8881 95TH ST
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33777-2521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7018 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2292
Country	:	US
Telephone Number	:	813-884-5705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	09/02/2016

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