Provider Demographics
NPI:1255715447
Name:TRASK, STEPHEN RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RICHARD
Last Name:TRASK
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 1:10 TSIENNETO RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1505
Mailing Address - Country:US
Mailing Address - Phone:603-965-0255
Mailing Address - Fax:603-965-0257
Practice Address - Street 1:10 TSIENNETO RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1505
Practice Address - Country:US
Practice Address - Phone:603-965-0255
Practice Address - Fax:603-965-0257
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1133183500000X
MA18084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist