Healthcare Provider Details

I. General information

NPI: 1619975539
Provider Name (Legal Business Name): WANDA M HUNT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH RD PSYCHIATRY DEPARTMENT
MANCHESTER NH
03104-7004
US

IV. Provider business mailing address

718 SMYTH RD
MANCHESTER NH
03104-7007
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-629-3244
Mailing address:
  • Phone: 603-624-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number3319
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: