Provider Demographics
NPI:1578009734
Name:LALIBERTE, DAWN (RPH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:LALIBERTE
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 1:2633 E VILLA PARK CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-2089
Mailing Address - Country:US
Mailing Address - Phone:480-414-1573
Mailing Address - Fax:
Practice Address - Street 1:3230 E CHANDLER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4261
Practice Address - Country:US
Practice Address - Phone:480-214-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS11176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist