Provider Demographics
NPI:1669174413
Name:ZERAI, SEGEN TECLAI
Entity type:Individual
Prefix:
First Name:SEGEN
Middle Name:TECLAI
Last Name:ZERAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 W KOWALSKY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4457
Mailing Address - Country:US
Mailing Address - Phone:602-475-8722
Mailing Address - Fax:
Practice Address - Street 1:1615 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6801
Practice Address - Country:US
Practice Address - Phone:602-276-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist