=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013517325
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA CARROLL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2020
-----------------------------------------------------
Last Update Date | 10/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 FARMINGTON RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03867-4352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-332-5540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 VARDON LN
-----------------------------------------------------
City | GREENLAND
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03840-2353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | R2048
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------