Provider Demographics
NPI:1316566508
Name:STENOIEN, JARED BENNETT (CPHT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:BENNETT
Last Name:STENOIEN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W 10TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4021
Mailing Address - Country:US
Mailing Address - Phone:480-310-0514
Mailing Address - Fax:
Practice Address - Street 1:8350 S RIVER PKWY
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2615
Practice Address - Country:US
Practice Address - Phone:480-310-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT037605183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT037605OtherPTCB