Healthcare Provider Details

I. General information

NPI: 1063732360
Provider Name (Legal Business Name): MAIRA DANIZZA ZEGARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 UNION AVE
LACONIA NH
03246-3115
US

IV. Provider business mailing address

52 ESTATES CIR APT 30
LACONIA NH
03246-3930
US

V. Phone/Fax

Practice location:
  • Phone: 603-528-1700
  • Fax:
Mailing address:
  • Phone: 617-959-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR2117
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26975
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: