Healthcare Provider Details

I. General information

NPI: 1538648548
Provider Name (Legal Business Name): JUSTIN RICHARD COUTURE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CALEF HWY
EPPING NH
03042-2203
US

IV. Provider business mailing address

576 FRANCESTOWN RD UNIT 701
BENNINGTON NH
03442-4337
US

V. Phone/Fax

Practice location:
  • Phone: 603-679-2419
  • Fax:
Mailing address:
  • Phone: 603-674-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3992
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: