Healthcare Provider Details

I. General information

NPI: 1407060734
Provider Name (Legal Business Name): PATRICIA ENO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SHADOW LAKE RD
SALEM NH
03079-1421
US

IV. Provider business mailing address

90 SHADOW LAKE RD
SALEM NH
03079-1421
US

V. Phone/Fax

Practice location:
  • Phone: 603-898-5045
  • Fax:
Mailing address:
  • Phone: 603-898-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2877
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22088
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: