MEDICARE: JENNIFER ANN WIRTZ R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	3342	NH

General Provider Information

NPI Number	:	1093317042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANN WIRTZ R.PH.

Provider Business Mailing Address
First Line	:	80 WOLFEBORO HWY
Second Line	:
City	:	ALTON
State	:	NH
Zip	:	03809-4953
Country	:	US
Telephone Number	:	603-875-5300
Fax Number	:	603-875-4310

Provider Business Practice Location Address
First Line	:	80 WOLFEBORO HWY
Second Line	:
City	:	ALTON
State	:	NH
Zip	:	03809-4953
Country	:	US
Telephone Number	:	603-875-5300
Fax Number	:	603-875-4310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	11/13/2020

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