Provider Demographics
NPI:1689705931
Name:TRUSTEES OF DARTMOUTH COLLEGE
Entity Type:Organization
Organization Name:TRUSTEES OF DARTMOUTH COLLEGE
Other - Org Name:DICK HALLS HOUSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC DEAN AND EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-646-9157
Mailing Address - Street 1:7 ROPE FERRY RD # 6143
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1404
Mailing Address - Country:US
Mailing Address - Phone:603-646-9456
Mailing Address - Fax:603-646-9447
Practice Address - Street 1:5 ROPE FERRY RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1404
Practice Address - Country:US
Practice Address - Phone:603-646-9456
Practice Address - Fax:603-646-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0012261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30704155Medicaid