Provider Demographics
NPI:1235412818
Name:BOUCHER, PAUL J (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 HOOKSETT RD
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1842
Mailing Address - Country:US
Mailing Address - Phone:603-647-2846
Mailing Address - Fax:603-627-6917
Practice Address - Street 1:1298 HOOKSETT RD
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1842
Practice Address - Country:US
Practice Address - Phone:603-647-2846
Practice Address - Fax:603-627-6917
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist