Healthcare Provider Details

I. General information

NPI: 1508699158
Provider Name (Legal Business Name): SERRANO MEDICAL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 3RD ST STE 100
LOS ANGELES CA
90020-3450
US

IV. Provider business mailing address

4220 W 3RD ST STE 100
LOS ANGELES CA
90020-3450
US

V. Phone/Fax

Practice location:
  • Phone: 213-384-3405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SEON YEONG HEO
Title or Position: CEO/CFO/SEC./DIR.
Credential:
Phone: 213-369-0447