Healthcare Provider Details

I. General information

NPI: 1164205738
Provider Name (Legal Business Name): LEAH KERERI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 9TH AVE
NEW YORK NY
10036-3659
US

IV. Provider business mailing address

661 9TH AVE
NEW YORK NY
10036-3659
US

V. Phone/Fax

Practice location:
  • Phone: 917-781-4503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051305687
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: