Provider Demographics
NPI:1386096253
Name:MILLER, SERRA GERMAINE
Entity type:Individual
Prefix:
First Name:SERRA
Middle Name:GERMAINE
Last Name:MILLER
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 1:4202 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1936
Mailing Address - Country:US
Mailing Address - Phone:315-487-0326
Mailing Address - Fax:315-487-0508
Practice Address - Street 1:4202 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1936
Practice Address - Country:US
Practice Address - Phone:315-487-0326
Practice Address - Fax:315-487-0508
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist