MEDICARE: DR. MOLLY MORTIMER PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	R1674	NH

General Provider Information

NPI Number	:	1750382479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY MORTIMER PHARM.D.

Provider Business Mailing Address
First Line	:	1 ELLIOT WAY
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ELLIOT WAY
Second Line	:	PHARMACY DEPT
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3502
Country	:	US
Telephone Number	:	603-663-2635
Fax Number	:

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/12/2020

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