Provider Demographics
NPI:1205989506
Name:SERIO BROTHERS, INC
Entity type:Organization
Organization Name:SERIO BROTHERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:987-874-5812
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1542
Mailing Address - Country:US
Mailing Address - Phone:978-874-5812
Mailing Address - Fax:978-874-1817
Practice Address - Street 1:128 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1542
Practice Address - Country:US
Practice Address - Phone:978-874-5812
Practice Address - Fax:978-874-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17103336C0003X, 3336C0004X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0436933Medicaid
MA110021839AMedicaid