Healthcare Provider Details

I. General information

NPI: 1174452296
Provider Name (Legal Business Name): GENESIS SEZATE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 S ESTRELLA CIR
MESA AZ
85202-6346
US

IV. Provider business mailing address

2136 S ESTRELLA CIR
MESA AZ
85202-6346
US

V. Phone/Fax

Practice location:
  • Phone: 319-538-1669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018117
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: