Healthcare Provider Details

I. General information

NPI: 1245544311
Provider Name (Legal Business Name): PATRICIA A JOHNSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2010
Last Update Date: 08/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N STATE ST
CONCORD NH
03301-5015
US

IV. Provider business mailing address

64 BROWN HILL RD
BOW NH
03304-4806
US

V. Phone/Fax

Practice location:
  • Phone: 603-223-6713
  • Fax:
Mailing address:
  • Phone: 603-774-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2705
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: