Provider Demographics
NPI:1912368168
Name:DUTTA, LEA (PHARMD;RPH)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:
Last Name:DUTTA
Suffix:
Gender:F
Credentials:PHARMD;RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 SAVOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1610
Mailing Address - Country:US
Mailing Address - Phone:732-447-5453
Mailing Address - Fax:
Practice Address - Street 1:281 SAVOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1610
Practice Address - Country:US
Practice Address - Phone:732-447-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061306183500000X
NJ28RI03324500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist