Healthcare Provider Details

I. General information

NPI: 1386633006
Provider Name (Legal Business Name): CHAD ERIC BEANE PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LAKE SHORE RD
GILFORD NH
03249-2249
US

IV. Provider business mailing address

29 AUDREY LN
LACONIA NH
03246-3065
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-5240
  • Fax: 603-528-8063
Mailing address:
  • Phone: 603-528-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3184
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: