Healthcare Provider Details

I. General information

NPI: 1821409681
Provider Name (Legal Business Name): PERFORMIX SPECIALTY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PELHAM RD SUITE 104
SALEM NH
03079-4851
US

IV. Provider business mailing address

25 PELHAM RD SUITE 104
SALEM NH
03079-4851
US

V. Phone/Fax

Practice location:
  • Phone: 603-870-9618
  • Fax: 603-870-9621
Mailing address:
  • Phone: 603-870-9618
  • Fax: 603-870-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0802
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NATALIE COTE
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 603-870-9618