Provider Demographics
NPI:1932484326
Name:ROUSSEAU, HOLLY MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:MARIE
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 THORNTON RD W
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4714
Mailing Address - Country:US
Mailing Address - Phone:603-494-5420
Mailing Address - Fax:
Practice Address - Street 1:571 NASHUA ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4924
Practice Address - Country:US
Practice Address - Phone:603-673-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist