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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0004X | Suppliers | Pharmacy | Compounding Pharmacy |
No | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |