Provider Demographics
NPI:1174142210
Name:ZHANG, SERENA
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 RIDGE TOP RD APT 438
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1121
Mailing Address - Country:US
Mailing Address - Phone:571-282-5113
Mailing Address - Fax:
Practice Address - Street 1:7651 MATAPEAKE BUSINESS DR STE 114
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3038
Practice Address - Country:US
Practice Address - Phone:571-282-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218027183500000X
MD26987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist