Provider Demographics
NPI:1245617729
Name:GREEN, SHARZAD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHARZAD
Middle Name:
Last Name:GREEN
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 1:658 E VINEDO LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1470
Mailing Address - Country:US
Mailing Address - Phone:480-264-7600
Mailing Address - Fax:
Practice Address - Street 1:658 E VINEDO LN
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1470
Practice Address - Country:US
Practice Address - Phone:480-264-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist