Healthcare Provider Details

I. General information

NPI: 1437556461
Provider Name (Legal Business Name): AMANDA NADEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 WAKEFIELD ST
ROCHESTER NH
03867-1304
US

IV. Provider business mailing address

11 STRATHAM LN
GREENLAND NH
03840-2126
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-3800
  • Fax:
Mailing address:
  • Phone: 603-988-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4010
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: