Provider Demographics
NPI:1568657740
Name:NORTHERN NEW ENGLAND COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:NORTHERN NEW ENGLAND COMPOUNDING PHARMACY
Other - Org Name:EASTERN STATES COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROCHEFORT
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:603-444-0094
Mailing Address - Street 1:338 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561
Mailing Address - Country:US
Mailing Address - Phone:603-444-0094
Mailing Address - Fax:
Practice Address - Street 1:338 UNION ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561
Practice Address - Country:US
Practice Address - Phone:603-444-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy