Provider Demographics
NPI:1033866363
Name:JIMENEZ, SIGRID HAZEL D (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIGRID HAZEL
Middle Name:D
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SIGRID HAZEL
Other - Middle Name:DUNGHIT
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:804 W ORION ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2735
Mailing Address - Country:US
Mailing Address - Phone:480-332-7919
Mailing Address - Fax:
Practice Address - Street 1:635 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6551
Practice Address - Country:US
Practice Address - Phone:602-323-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist