Healthcare Provider Details

I. General information

NPI: 1487773685
Provider Name (Legal Business Name): NICHOLAS ANDREW CARUSO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MARKET ST
WEST LEBANON NH
03784-4407
US

IV. Provider business mailing address

2407 US ROUTE 5 S
FAIRLEE VT
05045-9776
US

V. Phone/Fax

Practice location:
  • Phone: 603-298-6671
  • Fax: 603-298-6672
Mailing address:
  • Phone: 518-339-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3438
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: