Healthcare Provider Details

I. General information

NPI: 1487972949
Provider Name (Legal Business Name): JACQUELINE KAY TERKOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2010
Last Update Date: 05/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 WAKEFIELD ST
ROCHESTER NH
03867-1304
US

IV. Provider business mailing address

190 WAKEFIELD ST
ROCHESTER NH
03867-1304
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1131
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR4281
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00009759
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: