Healthcare Provider Details

I. General information

NPI: 1871807230
Provider Name (Legal Business Name): CHRISTOPHER HEFFERNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COMMERCIAL ST STE 2012
MANCHESTER NH
03101-1118
US

IV. Provider business mailing address

28 CADRAN XING
MILFORD NH
03055
US

V. Phone/Fax

Practice location:
  • Phone: 855-745-5725
  • Fax:
Mailing address:
  • Phone: 603-554-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5766
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: