MEDICARE: JAY CALABRO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	3576	NH

General Provider Information

NPI Number	:	1245830355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY CALABRO PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 837
Second Line	:
City	:	GLEN
State	:	NH
Zip	:	03838-0837
Country	:	US
Telephone Number	:	781-801-3972
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 N SOUTH RD
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5122
Country	:	US
Telephone Number	:	603-356-3170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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