Individual provider Active NPI

Serena Nicole Fasola, PHARMD

  • Pharmacist
  • Bala Cynwyd, PA
National Provider Identifier
1104730555
Registry record updated Oct 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RP460768 Issued in PA
Practice address
121 E City Ave
Bala Cynwyd, PA 19004-2485
Phone
(610) 667-7051
NPI assigned
Oct 1, 2026
Last updated
Oct 1, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RP460768 PA Primary

Addresses

Primary practice location

121 E City Ave
Bala Cynwyd, PA 19004-2485

Mailing address

24 Buckingham Dr
Egg Harbor TWP, NJ 08234-7253
Phone (609) 892-8394

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
RP460768PAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790812800000",
    "number": "1104730555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 BUCKINGHAM DR",
            "city": "EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "082347253",
            "telephone_number": "609-892-8394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E CITY AVE",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190042485",
            "telephone_number": "610-667-7051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASOLA",
        "first_name": "SERENA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-10-01",
        "last_updated": "2026-10-01",
        "certification_date": "2026-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP460768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bala Cynwyd, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.