Basic Information
| Provider Information | |||||||||
| NPI: | 1700091253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | WILLIAMS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5105 SW 95TH TER | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326084192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522242450 | ||||||||
| FaxNumber: | 3522242451 | ||||||||
| Practice Location | |||||||||
| Address1: | 4343 NEWBERRY ROAD | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522242450 | ||||||||
| FaxNumber: | 3522242451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS17042 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.