Provider Demographics
NPI:1154464311
Name:UNH HEALTH SERVICE PHARMACY
Entity type:Organization
Organization Name:UNH HEALTH SERVICE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:603-862-1094
Mailing Address - Street 1:4 PETTEE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-2344
Mailing Address - Country:US
Mailing Address - Phone:603-862-1094
Mailing Address - Fax:603-862-3229
Practice Address - Street 1:4 PETTEE BROOK LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2344
Practice Address - Country:US
Practice Address - Phone:603-862-1094
Practice Address - Fax:603-862-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0003X
NH02423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132732OtherPK