Provider Demographics
NPI:1821150806
Name:MARY HITCHCOCK MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MARY HITCHCOCK MEMORIAL HOSPITAL
Other - Org Name:DARTMOUTH-HITCHCOCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR, AO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-653-3785
Mailing Address - Street 1:1000 QUALITY DR
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2625
Mailing Address - Country:US
Mailing Address - Phone:603-653-3785
Mailing Address - Fax:603-653-3896
Practice Address - Street 1:1000 QUALITY DR
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-2625
Practice Address - Country:US
Practice Address - Phone:603-653-3785
Practice Address - Fax:603-653-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
NH03503336C0003X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2053042OtherPK
NH30005813Medicaid
VT1004201Medicaid
0688170001Medicare NSC