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General NPI Number Information
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NPI Number | 1548013329
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Entity Type | Organization
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Legal Business Name | GRANITE STATE COMPOUNDING AND WELLNESS PHARMACY, LLC
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 105 PONEMAH RD
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City | AMHERST
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State | NH
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Zip | 03031-2816
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Country | US
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Telephone | 603-870-9618
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Fax |
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Provider Business Mailing Address
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Address Line | 105 PONEMAH RD
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City | AMHERST
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State | NH
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Zip | 03031-2816
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Country | US
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Telephone | 603-325-2556
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MRS. NATALIE COTE
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Credential | PHARMD
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Telephone | 603-325-2556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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