Healthcare Provider Details

I. General information

NPI: 1063187995
Provider Name (Legal Business Name): RORY MOYLAN CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 DANIEL WEBSTER HWY
MERRIMACK NH
03054-3430
US

IV. Provider business mailing address

570 DANIEL WEBSTER HWY
MERRIMACK NH
03054-3430
US

V. Phone/Fax

Practice location:
  • Phone: 603-424-4519
  • Fax: 603-424-7910
Mailing address:
  • Phone: 603-424-4519
  • Fax: 603-424-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCPHT-04775
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: