=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598214751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAREMONT PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2016
-----------------------------------------------------
Last Update Date | 08/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 PLEASANT ST
-----------------------------------------------------
City | CLAREMONT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03743-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-542-6337
-----------------------------------------------------
Fax | 603-287-7139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 152
-----------------------------------------------------
City | LACONIA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03247-0152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-542-6337
-----------------------------------------------------
Fax | 603-287-7139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | CHAD BEANE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-542-6337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0811
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------