Provider Demographics
NPI:1134336779
Name:AUDET, JEFFREY J (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
Last Name:AUDET
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SOUTH SUMMER ST.
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03290
Mailing Address - Country:US
Mailing Address - Phone:603-679-8514
Mailing Address - Fax:
Practice Address - Street 1:35 FRESH RIVER RD
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042
Practice Address - Country:US
Practice Address - Phone:603-679-5942
Practice Address - Fax:603-679-5986
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist