Healthcare Provider Details

I. General information

NPI: 1811649700
Provider Name (Legal Business Name): LENA YACOUBIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MAIN ST
GARDNER MA
01440-2927
US

IV. Provider business mailing address

35 MADISON AVE
WINCHENDON MA
01475-2154
US

V. Phone/Fax

Practice location:
  • Phone: 978-630-2808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26457
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: