Healthcare Provider Details

I. General information

NPI: 1093317042
Provider Name (Legal Business Name): JENNIFER ANN WIRTZ R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WOLFEBORO HWY
ALTON NH
03809-4953
US

IV. Provider business mailing address

80 WOLFEBORO HWY
ALTON NH
03809-4953
US

V. Phone/Fax

Practice location:
  • Phone: 603-875-5300
  • Fax: 603-875-4310
Mailing address:
  • Phone: 603-875-5300
  • Fax: 603-875-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3342
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: