Healthcare Provider Details

I. General information

NPI: 1447467006
Provider Name (Legal Business Name): GEOFFREY A. RICKRODE PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR PHARMACY DEPARTMENT
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR PHARMACY DEPARTMENT
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5593
  • Fax: 603-650-4454
Mailing address:
  • Phone: 603-650-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3389
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: