MEDICARE: DR. PAVEL SERDYUK PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS52181	FL

General Provider Information

NPI Number	:	1740885334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAVEL SERDYUK PHARM D

Provider Business Mailing Address
First Line	:	8856 SAN ANDROS
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-5518
Country	:	US
Telephone Number	:	347-996-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	4465 NORTHLAKE BLVD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6255
Country	:	US
Telephone Number	:	561-622-6803
Fax Number	:	561-622-3893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/02/2020

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