Healthcare Provider Details

I. General information

NPI: 1073149894
Provider Name (Legal Business Name): PAUL SERAFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10937 FRONT ST
MOKENA IL
60448-1934
US

IV. Provider business mailing address

10937 FRONT ST
MOKENA IL
60448-1934
US

V. Phone/Fax

Practice location:
  • Phone: 708-995-5626
  • Fax: 708-995-5626
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051295989
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: