Provider Demographics
NPI:1578392692
Name:OHANYAN, SERENA (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SERENA
Middle Name:
Last Name:OHANYAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:JACOBS-LEVEILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:89 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2111
Mailing Address - Country:US
Mailing Address - Phone:774-570-1522
Mailing Address - Fax:
Practice Address - Street 1:71 SECOND AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1107
Practice Address - Country:US
Practice Address - Phone:781-622-3894
Practice Address - Fax:781-890-5630
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist