Provider Demographics
NPI:1740567007
Name:SERRANO, DEISY M (RPH)
Entity type:Individual
Prefix:MS
First Name:DEISY
Middle Name:M
Last Name:SERRANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9275 LOST VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4326
Mailing Address - Country:US
Mailing Address - Phone:775-852-3347
Mailing Address - Fax:775-852-3347
Practice Address - Street 1:305 LEMMON DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-6746
Practice Address - Country:US
Practice Address - Phone:775-677-6874
Practice Address - Fax:775-677-8651
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist