Provider Demographics
NPI:1609143130
Name:WENTWORTH-DOUGLASS HOSPITAL
Entity Type:Organization
Organization Name:WENTWORTH-DOUGLASS HOSPITAL
Other - Org Name:WENTWORTH-DOUGLASS HOSPITAL EMPLOYEE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEINKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-742-5252
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-3253
Mailing Address - Fax:
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-740-3253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WENTWORTH DOUGLASS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-29
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NH0634P3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132286OtherPK