Provider Demographics
NPI:1295214625
Name:DESROSIERS, CARLA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ANN
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 WOODBURY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2817
Mailing Address - Country:US
Mailing Address - Phone:603-430-4427
Mailing Address - Fax:603-430-8984
Practice Address - Street 1:2200 WOODBURY AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-2817
Practice Address - Country:US
Practice Address - Phone:603-430-4427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4440183500000X
MI5302026801183500000X
NHR1306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist