Provider Demographics
NPI:1124435656
Name:MASEREJIAN, LUCY (RPH)
Entity type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:
Last Name:MASEREJIAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3008
Mailing Address - Country:US
Mailing Address - Phone:978-369-3100
Mailing Address - Fax:
Practice Address - Street 1:1212 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3008
Practice Address - Country:US
Practice Address - Phone:978-369-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2021-03-02
Deactivation Date:2015-10-30
Deactivation Code:
Reactivation Date:2021-02-26
Provider Licenses
StateLicense IDTaxonomies
NH3187183500000X
MA24058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist