Healthcare Provider Details

I. General information

NPI: 1538360318
Provider Name (Legal Business Name): LORRAINE ESTELLE RADICK R.PH.,M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORRAINE ESTELLE RADICK R.PH.,M.S.

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MONT VERNON ST
MILFORD NH
03055-4120
US

IV. Provider business mailing address

8 KITTANSET ROAD
BEDFORD NH
03110
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-0224
  • Fax: 603-673-7644
Mailing address:
  • Phone: 603-622-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1659
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: