Healthcare Provider Details

I. General information

NPI: 1487234050
Provider Name (Legal Business Name): LUANNE MICHELLE GOMEZ CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W MAIN ST
HILLSBOROUGH NH
03244-5234
US

IV. Provider business mailing address

3 SPRING ST
HILLSBOROUGH NH
03244-4533
US

V. Phone/Fax

Practice location:
  • Phone: 603-464-5678
  • Fax:
Mailing address:
  • Phone: 603-540-4178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCPHT-125059
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: