Healthcare Provider Details

I. General information

NPI: 1962454116
Provider Name (Legal Business Name): STEVEN LYLE WHITCOMB PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH RD
MANCHESTER NH
03104-7004
US

IV. Provider business mailing address

30 OLD TOWN ROAD EXT
EPSOM NH
03234-4552
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-626-6562
Mailing address:
  • Phone: 603-736-4653
  • Fax: 603-736-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2195
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number2195
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: