Healthcare Provider Details

I. General information

NPI: 1588742092
Provider Name (Legal Business Name): PENACOOK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 VILLAGE ST
PENACOOK NH
03303-4508
US

IV. Provider business mailing address

305 VILLAGE ST
PENACOOK NH
03303-4508
US

V. Phone/Fax

Practice location:
  • Phone: 603-753-6391
  • Fax: 603-753-8664
Mailing address:
  • Phone: 603-753-6391
  • Fax: 603-753-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0180
License Number StateNH

VIII. Authorized Official

Name: ELIZABETH NAVOY
Title or Position: MANAGER
Credential: TECH
Phone: 603-753-6391