Healthcare Provider Details

I. General information

NPI: 1831194083
Provider Name (Legal Business Name): FARLEYS REXALL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BOULDER POINT DR.
PLYMOUTH NH
03264-1130
US

IV. Provider business mailing address

PO BOX 27
PLYMOUTH NH
03264-0027
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-1086
  • Fax: 603-536-5143
Mailing address:
  • Phone: 603-536-1086
  • Fax: 603-536-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0152P
License Number StateNH

VIII. Authorized Official

Name: MR. RALPH L OLIVER
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 603-536-1086