1740790674 NPI number — LISA BENDZ PHARMD, BCPS, CPP

Table of content: LISA BENDZ PHARMD, BCPS, CPP (NPI 1740790674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740790674 NPI number — LISA BENDZ PHARMD, BCPS, CPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENDZ
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, BCPS, CPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740790674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DUH PHARMACY DEPARTMENT, 14221 DUKE SOUTH, TRENT DRIVE
Provider Second Line Business Mailing Address:
DUMC BOX 3089
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-668-5429
Provider Business Mailing Address Fax Number:
919-681-3895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DUKE OUTPATIENT CLINIC
Provider Second Line Business Practice Location Address:
4220 NORTH ROXBORO RD
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27704-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-477-5904
Provider Business Practice Location Address Fax Number:
919-477-3110
Provider Enumeration Date:
10/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  0070-00952 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P1200X , with the licence number: 308009868 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 18914 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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