Healthcare Provider Details

I. General information

NPI: 1295214625
Provider Name (Legal Business Name): CARLA ANN DESROSIERS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WOODBURY AVE
NEWINGTON NH
03801-2817
US

IV. Provider business mailing address

2200 WOODBURY AVE
NEWINGTON NH
03801-2817
US

V. Phone/Fax

Practice location:
  • Phone: 603-430-4427
  • Fax:
Mailing address:
  • Phone: 603-430-4427
  • Fax: 603-430-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR4440
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026801
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1306
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: