Provider Demographics
NPI:1720364821
Name:BENADE, STEPHANIE
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:BENADE
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 1:1570 HIGHCREST DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9316
Mailing Address - Country:US
Mailing Address - Phone:541-779-7455
Mailing Address - Fax:
Practice Address - Street 1:915 NE D ST
Practice Address - Street 2:RITE AID PHARMACY STORE # 5386
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2320
Practice Address - Country:US
Practice Address - Phone:541-479-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist