Provider Demographics
NPI:1720713605
Name:SERDENA, MARVIN BRYAN
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:BRYAN
Last Name:SERDENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 HILLCREST LN
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7609
Mailing Address - Country:US
Mailing Address - Phone:630-730-9559
Mailing Address - Fax:
Practice Address - Street 1:1901 W 22ND ST
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1759
Practice Address - Country:US
Practice Address - Phone:630-730-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist