Provider Demographics
NPI:1518771740
Name:MITTS, SERENA JASMINE (PHARMD)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:JASMINE
Last Name:MITTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:JASMINE
Other - Last Name:TABBAA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1330 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3235
Practice Address - Country:US
Practice Address - Phone:440-949-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist