Provider Demographics
NPI:1255467411
Name:VIVENZIO, JAMES ROBERT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:VIVENZIO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 STEPHEN DR
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2481
Mailing Address - Country:US
Mailing Address - Phone:603-773-2901
Mailing Address - Fax:
Practice Address - Street 1:69 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2105
Practice Address - Country:US
Practice Address - Phone:603-778-0553
Practice Address - Fax:603-778-2587
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist