Provider Demographics
NPI:1326644592
Name:BRUNELLE, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BRUNELLE
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 1:351 E MONOMONAC RD
Mailing Address - Street 2:
Mailing Address - City:RINDGE
Mailing Address - State:NH
Mailing Address - Zip Code:03461-6026
Mailing Address - Country:US
Mailing Address - Phone:978-413-3769
Mailing Address - Fax:
Practice Address - Street 1:752 US ROUTE 202
Practice Address - Street 2:
Practice Address - City:RINDGE
Practice Address - State:NH
Practice Address - Zip Code:03461-5615
Practice Address - Country:US
Practice Address - Phone:603-899-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-00932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist