Provider Demographics
NPI:1194171975
Name:FORD, SERENITY BROOKE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SERENITY
Middle Name:BROOKE
Last Name:FORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 SEBASTIAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-8200
Mailing Address - Country:US
Mailing Address - Phone:772-581-5725
Mailing Address - Fax:
Practice Address - Street 1:1451 SEBASTIAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-8200
Practice Address - Country:US
Practice Address - Phone:772-581-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist