Provider Demographics
NPI:1043593858
Name:DEMINICO, STEPHEN JAMES
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:DEMINICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1299
Mailing Address - Country:US
Mailing Address - Phone:603-890-3147
Mailing Address - Fax:
Practice Address - Street 1:615 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2754
Practice Address - Country:US
Practice Address - Phone:603-423-9330
Practice Address - Fax:603-423-9336
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24046183500000X
NH3133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist