Provider Demographics
NPI:1164806519
Name:PU, SERENA WEI-JUNG
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:WEI-JUNG
Last Name:PU
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 1:7251 CAMINO ARROYO
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7340
Mailing Address - Country:US
Mailing Address - Phone:408-848-0702
Mailing Address - Fax:
Practice Address - Street 1:7251 CAMINO ARROYO
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7340
Practice Address - Country:US
Practice Address - Phone:408-842-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22621183500000X, 1835P0018X
CA725291835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist