Provider Demographics
NPI:1336638352
Name:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Entity Type:Organization
Organization Name:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Other - Org Name:ELLIOT PHARMACY AT BEDFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-5573
Mailing Address - Street 1:25 LEAVY DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4437
Mailing Address - Country:US
Mailing Address - Phone:603-472-1282
Mailing Address - Fax:603-472-1280
Practice Address - Street 1:25 LEAVY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-472-1282
Practice Address - Fax:603-472-1280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-04
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
NH044233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177469OtherPK
NHPENDINGMedicaid