Provider Demographics
NPI:1962003467
Name:BERTHA, LEANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:BERTHA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CENTRE OF NEW ENGLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6081
Mailing Address - Country:US
Mailing Address - Phone:401-823-7060
Mailing Address - Fax:
Practice Address - Street 1:650 CENTRE OF NEW ENGLAND BLVD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6081
Practice Address - Country:US
Practice Address - Phone:401-823-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012321183500000X
RIRPH05144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist