Active NPI
Varisa Mimi Serirodom, PHARM. D.
- Pharmacist
- Chicago, IL
National Provider Identifier
1497032395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051291605
- Practice address
- 8628 S Cottage Grove Ave
Chicago, IL 60619-6108 - Phone
- (773) 651-8500
- Fax
- (773) 874-0173
- NPI assigned
- Nov 7, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051291605 | IL | Primary |
Addresses
Primary practice location
8628 S Cottage Grove Ave
Chicago, IL 60619-6108
Mailing address
8775 S 80TH CT
Hickory Hills, IL 60457-1431
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
| License | State | Type | Specialty |
|---|---|---|---|
| 051291605 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320624000000",
"number": "1497032395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8775 S 80TH CT",
"city": "HICKORY HILLS",
"state": "IL",
"postal_code": "604571431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8628 S COTTAGE GROVE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606196108",
"telephone_number": "773-651-8500",
"fax_number": "773-874-0173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERIRODOM",
"first_name": "VARISA",
"middle_name": "MIMI",
"name_prefix": "Dr.",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-07",
"last_updated": "2011-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051291605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.