Healthcare Provider Details

I. General information

NPI: 1265421242
Provider Name (Legal Business Name): RICHARD A COHEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LORI LN
LONDONDERRY NH
03053-2378
US

IV. Provider business mailing address

17 LORI LN
LONDONDERRY NH
03053-2378
US

V. Phone/Fax

Practice location:
  • Phone: 203-253-9656
  • Fax:
Mailing address:
  • Phone: 203-253-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR2055
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH2736
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: