Provider Demographics
NPI:1699438499
Name:SERRANO SOTO, SHAIRA CORALYS (RPH)
Entity type:Individual
Prefix:
First Name:SHAIRA
Middle Name:CORALYS
Last Name:SERRANO SOTO
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 1:6121 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2579
Mailing Address - Country:US
Mailing Address - Phone:508-579-4134
Mailing Address - Fax:
Practice Address - Street 1:6121 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2579
Practice Address - Country:US
Practice Address - Phone:508-579-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241055183500000X
NC31943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist