Provider Demographics
NPI:1174839807
Name:SERAFICA, TEODORA C
Entity Type:Individual
Prefix:
First Name:TEODORA
Middle Name:C
Last Name:SERAFICA
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 1:219 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3215
Mailing Address - Country:US
Mailing Address - Phone:201-488-7224
Mailing Address - Fax:201-488-2394
Practice Address - Street 1:219 ESSEX ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3215
Practice Address - Country:US
Practice Address - Phone:201-488-7224
Practice Address - Fax:201-488-2394
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02931500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist