Provider Demographics
NPI:1366788465
Name:SAN BUENAVENTURA, ANNE MAIGUE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MAIGUE
Last Name:SAN BUENAVENTURA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8724
Mailing Address - Country:US
Mailing Address - Phone:864-486-4706
Mailing Address - Fax:864-486-4713
Practice Address - Street 1:2153 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8724
Practice Address - Country:US
Practice Address - Phone:864-486-4706
Practice Address - Fax:864-486-4713
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC16511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist