Provider Demographics
NPI:1295086809
Name:SERWETMAN, LEA (PHARMD, CGP)
Entity type:Individual
Prefix:DR
First Name:LEA
Middle Name:
Last Name:SERWETMAN
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KENDRICK ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2724
Mailing Address - Country:US
Mailing Address - Phone:617-640-1621
Mailing Address - Fax:781-449-1453
Practice Address - Street 1:117 KENDRICK ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2724
Practice Address - Country:US
Practice Address - Phone:617-640-1621
Practice Address - Fax:781-449-1453
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA270521835G0303X
NHR23461835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric