Provider Demographics
NPI:1609529239
Name:SOUTHWICK, BRONWIN (CPHT)
Entity Type:Individual
Prefix:
First Name:BRONWIN
Middle Name:
Last Name:SOUTHWICK
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 THORNDIKE POND RD
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-5139
Mailing Address - Country:US
Mailing Address - Phone:603-562-4902
Mailing Address - Fax:
Practice Address - Street 1:14 PETERBOROUGH ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-5857
Practice Address - Country:US
Practice Address - Phone:603-532-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCPHT-124219183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician