Provider Demographics
NPI:1083232326
Name:ALEXISHIN, SERGE ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SERGE
Middle Name:ALEXANDER
Last Name:ALEXISHIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10270 MILL RUN CIR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4214
Mailing Address - Country:US
Mailing Address - Phone:443-501-7053
Mailing Address - Fax:443-501-7044
Practice Address - Street 1:10270 MILL RUN CIR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4214
Practice Address - Country:US
Practice Address - Phone:443-501-7053
Practice Address - Fax:443-501-7044
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27321183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist