Provider Demographics
NPI:1972383271
Name:DIBENEDETTO, BRIANA
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:DIBENEDETTO
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 1:8024 W GIDDINGS ST
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4447
Mailing Address - Country:US
Mailing Address - Phone:708-510-8722
Mailing Address - Fax:
Practice Address - Street 1:800 DEVON AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4760
Practice Address - Country:US
Practice Address - Phone:847-825-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.305879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist