Individual
EDIAN BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2435 E BASELINE RD, PHOENIX, AZ 85042-7004
(602) 232-2982
Mailing address
2435 E BASELINE RD, PHOENIX, AZ 85042-7004
(602) 232-2982
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S026904
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051.303055
IDFPR
IL
Enumeration date
06/19/2020
Last updated
12/24/2024
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