Provider Demographics
NPI:1447305883
Name:HINES, JACINTA BONITA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACINTA
Middle Name:BONITA
Last Name:HINES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 E TIERRA BUENA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3360
Mailing Address - Country:US
Mailing Address - Phone:602-282-1974
Mailing Address - Fax:602-282-1975
Practice Address - Street 1:4857 E GREENWAY RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1686
Practice Address - Country:US
Practice Address - Phone:602-282-1974
Practice Address - Fax:602-282-1975
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist