Provider Demographics
NPI:1922390350
Name:MAILHOT, MARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:MAILHOT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 LOST NATION RD
Mailing Address - Street 2:
Mailing Address - City:GROVETON
Mailing Address - State:NH
Mailing Address - Zip Code:03582-4516
Mailing Address - Country:US
Mailing Address - Phone:603-636-9819
Mailing Address - Fax:
Practice Address - Street 1:177 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3034
Practice Address - Country:US
Practice Address - Phone:603-788-2433
Practice Address - Fax:603-788-0915
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist