Provider Demographics
NPI:1710759295
Name:SERRANO, SERJIO (CPHT)
Entity Type:Individual
Prefix:
First Name:SERJIO
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 SHAWNEE DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5977
Mailing Address - Country:US
Mailing Address - Phone:503-983-6597
Mailing Address - Fax:
Practice Address - Street 1:406 MCCLAINE ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1921
Practice Address - Country:US
Practice Address - Phone:503-873-8391
Practice Address - Fax:503-873-2900
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0013973183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician