Healthcare Provider Details

I. General information

NPI: 1376234443
Provider Name (Legal Business Name): MELISSA PAVNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FORT EDDY RD
CONCORD NH
03301-7404
US

IV. Provider business mailing address

246 1ST NH TPKE
NORTHWOOD NH
03261-3404
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-7784
  • Fax:
Mailing address:
  • Phone: 603-717-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHT129236
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: