Provider Demographics
NPI:1851942080
Name:BENVEGU, CLAIRE JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:JEAN
Last Name:BENVEGU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 E WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6621
Mailing Address - Country:US
Mailing Address - Phone:801-573-1323
Mailing Address - Fax:801-328-6027
Practice Address - Street 1:455 S 500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2753
Practice Address - Country:US
Practice Address - Phone:801-328-6033
Practice Address - Fax:801-328-6027
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT148702-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT148702-1701OtherUTAH PHARMACY LICENSE #