=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790996429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH E LAFOREST RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 281 N STATE ST
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-3227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-271-6480
-----------------------------------------------------
Fax | 603-271-6479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 MEADOW LARK LN
-----------------------------------------------------
City | GOFFSTOWN
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03045-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-497-3597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | R738
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------