Healthcare Provider Details

I. General information

NPI: 1932295623
Provider Name (Legal Business Name): PATRICIA POMEROY CALLAHAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER 718 SMYTH ROAD
MANCHESTER NH
03104
US

IV. Provider business mailing address

100 SOUTH ROAD
DEERFIELD NH
03037
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-626-6562
Mailing address:
  • Phone: 603-463-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2714
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: