Provider Demographics
NPI:1164032850
Name:FERRIS, SERENA ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:ROSE
Last Name:FERRIS
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 1:5375 NE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OR
Mailing Address - Zip Code:97495-8927
Mailing Address - Country:US
Mailing Address - Phone:503-358-2286
Mailing Address - Fax:
Practice Address - Street 1:1430 NW GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1766
Practice Address - Country:US
Practice Address - Phone:541-673-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist