Provider Demographics
NPI:1427232701
Name:SERIO, RYAN N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:N
Last Name:SERIO
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 1:4228 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3822
Mailing Address - Country:US
Mailing Address - Phone:718-886-7789
Mailing Address - Fax:718-463-3669
Practice Address - Street 1:4228 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3822
Practice Address - Country:US
Practice Address - Phone:718-886-7789
Practice Address - Fax:718-463-3669
Is Sole Proprietor?:No
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02527053Medicaid