=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609143130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WENTWORTH-DOUGLASS HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2011
-----------------------------------------------------
Last Update Date | 07/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 789 CENTRAL AVE
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-740-3253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 789 CENTRAL AVE
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03820-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-740-3253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY SERVICES
-----------------------------------------------------
Name | RICHARD MEINKING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-742-5252
-----------------------------------------------------
=====================================================
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 | 0634P
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------