MEDICARE: JUSTIN SERRANO

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	053593	NY

General Provider Information

NPI Number	:	1891108437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN SERRANO

Provider Business Mailing Address
First Line	:	581 CENTRAL AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1914
Country	:	US
Telephone Number	:	518-453-0021
Fax Number	:	518-453-0328

Provider Business Practice Location Address
First Line	:	581 CENTRAL AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1914
Country	:	US
Telephone Number	:	518-453-0021
Fax Number	:	518-453-0328

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

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	06/10/2014

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Directions to “ JUSTIN SERRANO ” Practice Location

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