Provider Demographics
NPI:1124714852
Name:BENETT, JESSICA RENEE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:BENETT
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 1:3095 MCMURRAY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3674
Mailing Address - Country:US
Mailing Address - Phone:530-365-5753
Mailing Address - Fax:530-365-4408
Practice Address - Street 1:3095 MCMURRAY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3674
Practice Address - Country:US
Practice Address - Phone:530-365-5753
Practice Address - Fax:530-365-4408
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133224183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician