Provider Demographics
NPI:1376090951
Name:CARON, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CARON
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 1:1 MILL ST
Mailing Address - Street 2:UNIT 204
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4560
Mailing Address - Country:US
Mailing Address - Phone:978-857-7976
Mailing Address - Fax:
Practice Address - Street 1:338 HIGH ST
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878
Practice Address - Country:US
Practice Address - Phone:603-382-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist