Healthcare Provider Details

I. General information

NPI: 1306358403
Provider Name (Legal Business Name): PETER T KUTCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 ELM ST
MANCHESTER NH
03101-1207
US

IV. Provider business mailing address

8 COUNTRY CLUB DR APT 2
MANCHESTER NH
03102-8769
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-4393
  • Fax:
Mailing address:
  • Phone: 603-203-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-04355
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: