Provider Demographics
NPI:1457602229
Name:GEORGE, SERENE ANGADIATH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SERENE
Middle Name:ANGADIATH
Last Name:GEORGE
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 1:12049 ASHTON MANOR WAY
Mailing Address - Street 2:APT 110
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7018
Mailing Address - Country:US
Mailing Address - Phone:954-608-5007
Mailing Address - Fax:
Practice Address - Street 1:325 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7012
Practice Address - Country:US
Practice Address - Phone:407-482-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist