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General NPI Number Information
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NPI Number | 1558957258
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Entity Type | Individual
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Provider Name | DYLAN MICHAEL LABARGE
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Gender | Male
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 481 WEST ST
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City | KEENE
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State | NH
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Zip | 03431-2448
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Country | US
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Telephone | 603-357-0423
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Fax |
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Provider Business Mailing Address
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Address Line | 62 ROXBURY ST UNIT 133
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City | KEENE
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State | NH
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Zip | 03431-3075
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Country | US
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Telephone | 518-536-0198
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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 | PHCY-01062
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License Number State | NH
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