Provider Demographics
NPI:1629350491
Name:CAFAZZO, ROBIN
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:CAFAZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03841
Mailing Address - Country:US
Mailing Address - Phone:603-893-3667
Mailing Address - Fax:603-890-3528
Practice Address - Street 1:167 BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03841
Practice Address - Country:US
Practice Address - Phone:603-893-3667
Practice Address - Fax:603-890-3528
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1037183500000X
MAPH17770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist