Provider Demographics
NPI:1013015148
Name:BOUCHARD, SANDY ANN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:ANN
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:GAMACHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:57 FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2815
Mailing Address - Country:US
Mailing Address - Phone:978-630-4589
Mailing Address - Fax:
Practice Address - Street 1:750 US ROUTE 202
Practice Address - Street 2:
Practice Address - City:RINDGE
Practice Address - State:NH
Practice Address - Zip Code:03461
Practice Address - Country:US
Practice Address - Phone:603-899-6965
Practice Address - Fax:603-899-6972
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3414183500000X
MA26073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH4355050957Medicare ID - Type Unspecified