Provider Demographics
NPI:1447548706
Name:BENNETT, JOHANNE ELIZABETH
Entity type:Individual
Prefix:
First Name:JOHANNE
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-3748
Mailing Address - Country:US
Mailing Address - Phone:785-238-1000
Mailing Address - Fax:785-238-5555
Practice Address - Street 1:407 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3748
Practice Address - Country:US
Practice Address - Phone:785-238-1000
Practice Address - Fax:785-238-5555
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22000OtherNC LICENSE
KS1-17064OtherKS LICENSE