Provider Demographics
NPI:1184997330
Name:SERNA, KATHERINE GRACE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHERINE GRACE
Middle Name:
Last Name:SERNA
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 1:1200 S CONKLING ST APT 233
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5298
Mailing Address - Country:US
Mailing Address - Phone:904-716-9178
Mailing Address - Fax:
Practice Address - Street 1:2310 W PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2816
Practice Address - Country:US
Practice Address - Phone:410-646-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist