Provider Demographics
NPI:1982001079
Name:RUIZ SERRANO, LARISA MERCEDES (PHARMD)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:MERCEDES
Last Name:RUIZ SERRANO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 NE 2ND ST
Mailing Address - Street 2:310-S
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2285
Mailing Address - Country:US
Mailing Address - Phone:787-375-6150
Mailing Address - Fax:
Practice Address - Street 1:253 NE 2ND ST
Practice Address - Street 2:310-S
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2285
Practice Address - Country:US
Practice Address - Phone:787-375-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist