Provider Demographics
NPI:1316043714
Name:SERRANO, CARMEN LIZZETTE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:LIZZETTE
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:URB. PAISAJE DEL LAGO
Mailing Address - Street 2:65 CAMINO DEL CAMPO
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2532
Mailing Address - Country:US
Mailing Address - Phone:787-889-7214
Mailing Address - Fax:
Practice Address - Street 1:CARR. 3 KM 28.8
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-2602
Practice Address - Fax:787-809-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4141OtherPHARMACIST LICENSE