Provider Demographics
NPI:1710583802
Name:BENNETT, MADELINE CADLE (PHARMD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:CADLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:ANNE
Other - Last Name:CADLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:701 NW SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5202
Mailing Address - Country:US
Mailing Address - Phone:580-353-3948
Mailing Address - Fax:
Practice Address - Street 1:1213 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4986
Practice Address - Country:US
Practice Address - Phone:270-886-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19025183500000X
KY0233961835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist