Healthcare Provider Details

I. General information

NPI: 1851183404
Provider Name (Legal Business Name): LARA ABOUSAMRA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

10 MUSEUM WAY APT 1629
CAMBRIDGE MA
02141-1898
US

V. Phone/Fax

Practice location:
  • Phone: 857-215-1311
  • Fax:
Mailing address:
  • Phone: 857-408-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH237787
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH237787
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH237787
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: