Provider Demographics
NPI:1437269891
Name:SERRI, AMIR (RPH)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:SERRI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 S POWERLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069
Mailing Address - Country:US
Mailing Address - Phone:954-972-1822
Mailing Address - Fax:
Practice Address - Street 1:1247 S POWERLINE ROAD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:954-972-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0038001183500000X
CA53232183500000X
MI5302031591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030968100Medicaid
FL030968100Medicaid