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General NPI Number Information
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NPI Number | 1720364821
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Entity Type | Individual
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Provider Name | MRS. STEPHANIE BENADE
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Gender | Female
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 915 NE D ST RITE AID PHARMACY STORE # 5386
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City | GRANTS PASS
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State | OR
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Zip | 97526-2320
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Country | US
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Telephone | 541-479-3358
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 HIGHCREST DR
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City | MEDFORD
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State | OR
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Zip | 97504-9316
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Country | US
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Telephone | 541-779-7455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0013414
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License Number State | OR
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