Provider Demographics
NPI:1083999452
Name:BENADE, LIZETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LIZETTE
Middle Name:
Last Name:BENADE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2237
Mailing Address - Country:US
Mailing Address - Phone:602-843-0351
Mailing Address - Fax:602-547-8281
Practice Address - Street 1:5040 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2237
Practice Address - Country:US
Practice Address - Phone:602-843-0351
Practice Address - Fax:602-547-8281
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist