Healthcare Provider Details

I. General information

NPI: 1326791716
Provider Name (Legal Business Name): SEAN BENFIELD COSNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 BENJAMIN RD STE 709
TAMPA FL
33634-5174
US

IV. Provider business mailing address

6308 BENJAMIN RD STE 709
TAMPA FL
33634-5174
US

V. Phone/Fax

Practice location:
  • Phone: 727-896-0001
  • Fax: 727-896-0002
Mailing address:
  • Phone: 727-896-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT82317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: