MEDICARE: BENNETT WHOLESALE DISTRIBUTORS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BC3200X	Customized Equipment (DME)
2	291U00000X	Clinical Medical Laboratory
3	332BD1200X	Dialysis Equipment & Supplies (DME)
4	332BN1400X	Nursing Facility Supplies (DME)
5	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
6	332BX2000X	Oxygen Equipment & Supplies (DME)
7	333600000X	Pharmacy
8	3336C0002X	Clinic Pharmacy
9	3336C0003X	Community/Retail Pharmacy
10	3336C0004X	Compounding Pharmacy
11	3336I0012X	Institutional Pharmacy
12	3336L0003X	Long Term Care Pharmacy
13	3336M0002X	Mail Order Pharmacy
14	3336S0011X	Specialty Pharmacy
15	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1588217830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENNETT WHOLESALE DISTRIBUTORS, LLC

Provider Business Mailing Address
First Line	:	300 LONG POINTE LN STE 220-O
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7543
Country	:	US
Telephone Number	:	800-650-0616
Fax Number	:	800-650-0616

Provider Business Practice Location Address
First Line	:	300 LONG POINTE LN STE 220-O
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7543
Country	:	US
Telephone Number	:	800-650-0616
Fax Number	:	800-650-0616

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMEEL BENNETT SR.
Credential	:
Telephone Number	:	800-650-0616

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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