Provider Demographics
NPI:1740834654
Name:BENEDICT, MICHAEL PAINTER (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAINTER
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 N FIESTA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1032
Mailing Address - Country:US
Mailing Address - Phone:480-253-3100
Mailing Address - Fax:866-663-0158
Practice Address - Street 1:1275 W WASHINGTON ST STE 105
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1859
Practice Address - Country:US
Practice Address - Phone:480-240-1111
Practice Address - Fax:480-240-1112
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist