Provider Demographics
NPI:1619113313
Name:SERUSA, CARLO F JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARLO
Middle Name:F
Last Name:SERUSA
Suffix:JR
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 1:355 ORO DAM BLVD E
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5713
Mailing Address - Country:US
Mailing Address - Phone:530-534-1495
Mailing Address - Fax:530-534-9508
Practice Address - Street 1:355 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5713
Practice Address - Country:US
Practice Address - Phone:530-534-1495
Practice Address - Fax:530-534-9508
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist