Healthcare Provider Details

I. General information

NPI: 1891074647
Provider Name (Legal Business Name): AUDREY RENEE BROYER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY RENEE COURCHESNE

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH RD
MANCHESTER NH
03104-7007
US

IV. Provider business mailing address

718 SMYTH RD
MANCHESTER NH
03104-7007
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax:
Mailing address:
  • Phone: 603-624-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3702
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: