Provider Demographics
NPI:1598896573
Name:SERIO, THOMAS S (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:SERIO
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 1:93 LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2836
Mailing Address - Country:US
Mailing Address - Phone:631-472-9810
Mailing Address - Fax:631-727-3054
Practice Address - Street 1:849 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2106
Practice Address - Country:US
Practice Address - Phone:631-727-0550
Practice Address - Fax:631-727-3054
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist