Provider Demographics
NPI:1346688777
Name:LACASSE, DAVID COLIN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:COLIN
Last Name:LACASSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2258
Mailing Address - Country:US
Mailing Address - Phone:603-425-2042
Mailing Address - Fax:
Practice Address - Street 1:52 ROCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4126
Practice Address - Country:US
Practice Address - Phone:603-432-2505
Practice Address - Fax:603-432-8470
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18884183500000X
NH2364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist