Healthcare Provider Details

I. General information

NPI: 1649484379
Provider Name (Legal Business Name): CHESHIRE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COURT ST
KEENE NH
03431-1718
US

IV. Provider business mailing address

580 COURT ST
KEENE NH
03431-1718
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-6548
  • Fax: 603-354-6547
Mailing address:
  • Phone: 603-354-6548
  • Fax: 603-354-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DENIS PAUL FORTIER
Title or Position: DIRECTOR, PHARMACY
Credential: R.PH.
Phone: 603-354-6548