Provider Demographics
NPI:1659095487
Name:BAILIN, SERENA ROSE (RP)
Entity Type:Individual
Prefix:MS
First Name:SERENA
Middle Name:ROSE
Last Name:BAILIN
Suffix:
Gender:F
Credentials:RP
Other - Prefix:MS
Other - First Name:SERENA
Other - Middle Name:ROSE
Other - Last Name:RICE-BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1099 GERMANTOWN AVENUE
Mailing Address - Street 2:G0908
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123
Mailing Address - Country:US
Mailing Address - Phone:323-304-9835
Mailing Address - Fax:
Practice Address - Street 1:400 S STATE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1243
Practice Address - Country:US
Practice Address - Phone:610-605-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist