Healthcare Provider Details

I. General information

NPI: 1962567537
Provider Name (Legal Business Name): MARTIN STEPHEN DONOVAN R.PH., DCN, DIP HERB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 LOUDON RD STE 1A
CONCORD NH
03301-6091
US

IV. Provider business mailing address

239 LOUDON RD STE 1A
CONCORD NH
03301-6091
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2747
  • Fax: 603-227-6170
Mailing address:
  • Phone: 603-225-2747
  • Fax: 603-227-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR933
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: