Healthcare Provider Details

I. General information

NPI: 1881031854
Provider Name (Legal Business Name): ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 QUEEN CITY AVE SUITE 1
MANCHESTER NH
03101
US

IV. Provider business mailing address

175 QUEEN CITY AVE SUITE 1
MANCHESTER NH
03101
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-5678
  • Fax: 603-663-3202
Mailing address:
  • Phone: 603-663-5678
  • Fax: 603-663-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0635
License Number StateNH

VIII. Authorized Official

Name: RICHARD MAXWELL
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 603-663-5573