Provider Demographics
NPI:1609415678
Name:QUIMBY, JESSE IAN
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:IAN
Last Name:QUIMBY
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 1:235 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-5817
Mailing Address - Country:US
Mailing Address - Phone:603-664-2969
Mailing Address - Fax:
Practice Address - Street 1:1303 WOODBURY AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3217
Practice Address - Country:US
Practice Address - Phone:603-431-1580
Practice Address - Fax:603-431-2914
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist