Healthcare Provider Details

I. General information

NPI: 1578392692
Provider Name (Legal Business Name): SERENA OHANYAN PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SERENA JACOBS-LEVEILLE PHARMD, RPH

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 SECOND AVE
WALTHAM MA
02451-1107
US

IV. Provider business mailing address

89 TURNPIKE RD
SOUTHBOROUGH MA
01772-2111
US

V. Phone/Fax

Practice location:
  • Phone: 781-622-3894
  • Fax: 781-890-5630
Mailing address:
  • Phone: 774-570-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH240469
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: