=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417497017
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS SAMUEL PATTISON JR. PHARMD, RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2017
-----------------------------------------------------
Last Update Date | 03/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 PETERBOROUGH ST
-----------------------------------------------------
City | JAFFREY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03452-5857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-532-6955
-----------------------------------------------------
Fax | 603-532-4197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 PETERBOROUGH ST
-----------------------------------------------------
City | JAFFREY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03452-5857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-532-6955
-----------------------------------------------------
Fax | 603-532-4197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | R2771
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------