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General NPI Number Information
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NPI Number | 1548724503
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Entity Type | Individual
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Provider Name | JAKE SCOTT LANDRY RPH
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Gender | Male
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 250 COMMERCIAL ST
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City | MANCHESTER
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State | NH
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Zip | 03101-1142
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Country | US
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Telephone | 855-745-5725
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Fax |
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Provider Business Mailing Address
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Address Line | 24 SYLVAN ST
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City | MELROSE
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State | MA
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Zip | 02176-5237
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Country | US
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Telephone | 781-697-0644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH238320
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHCY-04503
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License Number State | NH
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