Provider Demographics
NPI:1376842088
Name:SERRANO, JENICE ZOETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JENICE
Middle Name:ZOETH
Last Name:SERRANO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LA ALHAMBRA #2604 REINA MORA ST
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-366-8265
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE TOMAS CARRION MADURO
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1642
Practice Address - Country:US
Practice Address - Phone:787-837-2139
Practice Address - Fax:787-837-5911
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5452183500000X
FLPS47064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist