Provider Demographics
NPI:1881031854
Name:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Entity Type:Organization
Organization Name:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Other - Org Name:ELLIOT PHARMACY AT RIVER'S EDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-5573
Mailing Address - Street 1:175 QUEEN CITY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-663-5678
Mailing Address - Fax:603-663-3202
Practice Address - Street 1:175 QUEEN CITY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-663-5678
Practice Address - Fax:603-663-3202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-30
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH06353336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0635OtherSTATE PHARMACY PERMIT NUMBER
NH3084310Medicaid