Healthcare Provider Details

I. General information

NPI: 1518210616
Provider Name (Legal Business Name): MR. JIM NIXON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 HIGH WATCH RD
EFFINGHAM NH
03882-8336
US

IV. Provider business mailing address

7 EASTSIDE RD APT # 1
NORTH CONWAY NH
03860
US

V. Phone/Fax

Practice location:
  • Phone: 603-539-8780
  • Fax: 603-539-8824
Mailing address:
  • Phone: 603-539-8780
  • Fax: 603-539-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR953
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: