Provider Demographics
NPI:1174857627
Name:DEDONATO, BETHANY MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:MICHELLE
Last Name:DEDONATO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:BETHANY
Other - Middle Name:MICHELLE
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1700 MOUNT VERNON AVE
Mailing Address - Street 2:CLINICAL PHARMACY
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 MOUNT VERNON AVE
Practice Address - Street 2:CLINICAL PHARMACY
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4018
Practice Address - Country:US
Practice Address - Phone:661-326-5567
Practice Address - Fax:661-862-7684
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625421835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy