Provider Demographics
NPI:1609145630
Name:COMPOUNDING PHARMACY OF SOUTHERN NEW HAMPSHIRE INC
Entity type:Organization
Organization Name:COMPOUNDING PHARMACY OF SOUTHERN NEW HAMPSHIRE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PULEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-845-5155
Mailing Address - Street 1:1 COMMONS DR # C
Mailing Address - Street 2:UNIT 17
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3441
Mailing Address - Country:US
Mailing Address - Phone:603-845-5155
Mailing Address - Fax:603-845-5154
Practice Address - Street 1:1C COMMONS DR UNIT 17
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3441
Practice Address - Country:US
Practice Address - Phone:603-845-5155
Practice Address - Fax:603-845-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NH0777 P3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136237OtherPK