Provider Demographics
NPI:1992330336
Name:HOMSI, SERIN (RPH)
Entity type:Individual
Prefix:
First Name:SERIN
Middle Name:
Last Name:HOMSI
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 1:5590 W 9TH ST APT 214
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-2824
Mailing Address - Country:US
Mailing Address - Phone:630-518-6649
Mailing Address - Fax:
Practice Address - Street 1:860 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4867
Practice Address - Country:US
Practice Address - Phone:507-452-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist