Healthcare Provider Details

I. General information

NPI: 1427448182
Provider Name (Legal Business Name): KAYLA HARRINGTON-BOULE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 DAMANTE DR
CONCORD NH
03301-5759
US

IV. Provider business mailing address

80 DAMANTE DR
CONCORD NH
03301-5759
US

V. Phone/Fax

Practice location:
  • Phone: 603-227-0816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT3834
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: