Provider Demographics
NPI:1194293563
Name:SERRANO, ISAIAS (RPH)
Entity type:Individual
Prefix:
First Name:ISAIAS
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
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:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-1646
Mailing Address - Country:US
Mailing Address - Phone:787-379-4545
Mailing Address - Fax:
Practice Address - Street 1:URB ALTURAS DE RIO GRANDE CARR 3
Practice Address - Street 2:LOCAL HH17-18
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist