Healthcare Provider Details

I. General information

NPI: 1780496737
Provider Name (Legal Business Name): STEPHANIE ZIDAR PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 N GRACE BLVD
CHANDLER AZ
85225-3416
US

IV. Provider business mailing address

4045 S TAYLOR DR
TEMPE AZ
85282-5870
US

V. Phone/Fax

Practice location:
  • Phone: 844-785-0428
  • Fax:
Mailing address:
  • Phone: 480-273-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS027295
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: