Healthcare Provider Details

I. General information

NPI: 1902214315
Provider Name (Legal Business Name): TATIANA OBUKHOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ATWOOD RD
PELHAM NH
03076-3715
US

IV. Provider business mailing address

48 ATWOOD RD
PELHAM NH
03076-3715
US

V. Phone/Fax

Practice location:
  • Phone: 603-635-7996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3970
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: