Healthcare Provider Details

I. General information

NPI: 1609145630
Provider Name (Legal Business Name): COMPOUNDING PHARMACY OF SOUTHERN NEW HAMPSHIRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1C COMMONS DR UNIT 17
LONDONDERRY NH
03053-3441
US

IV. Provider business mailing address

1 COMMONS DR # C UNIT 17
LONDONDERRY NH
03053-3441
US

V. Phone/Fax

Practice location:
  • Phone: 603-845-5155
  • Fax: 603-845-5154
Mailing address:
  • Phone: 603-845-5155
  • Fax: 603-845-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0777 P
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEAN PULEO
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 603-845-5155