Provider Demographics
NPI:1609646751
Name:BENARES, SHEAN ABIGAIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHEAN
Middle Name:ABIGAIL
Last Name:BENARES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 S AMULET
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2784
Mailing Address - Country:US
Mailing Address - Phone:956-533-0158
Mailing Address - Fax:
Practice Address - Street 1:1159 S AMULET
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2784
Practice Address - Country:US
Practice Address - Phone:956-533-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist