Provider Demographics
NPI:1922121094
Name:GREATER DERRY COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:GREATER DERRY COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:603-425-2604
Mailing Address - Street 1:41 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2119
Mailing Address - Country:US
Mailing Address - Phone:603-425-2604
Mailing Address - Fax:603-425-2604
Practice Address - Street 1:41 BIRCH ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2119
Practice Address - Country:US
Practice Address - Phone:603-425-2604
Practice Address - Fax:603-425-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHBG5131658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30700397Medicaid