=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538373311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. JENNIFER KATE FORD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 FRESH RIVER RD
-----------------------------------------------------
City | EPPING
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03042-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-679-5942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 134 LEAVITT RD
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03044-3121
-----------------------------------------------------
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 | 2947
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------