Healthcare Provider Details

I. General information

NPI: 1023519576
Provider Name (Legal Business Name): THOMAS LANDRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 MAMMOTH RD
HOOKSETT NH
03106-1155
US

IV. Provider business mailing address

82 MAMMOTH RD
HOOKSETT NH
03106-1155
US

V. Phone/Fax

Practice location:
  • Phone: 603-913-5764
  • Fax:
Mailing address:
  • Phone: 603-913-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHT07288
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: