Provider Demographics
NPI:1093364531
Name:KING, JAIME BARLOW
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:BARLOW
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PINE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2710
Mailing Address - Country:US
Mailing Address - Phone:603-505-7016
Mailing Address - Fax:
Practice Address - Street 1:15 MONT VERNON ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4120
Practice Address - Country:US
Practice Address - Phone:603-673-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-00891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist