Provider Demographics
NPI:1194980656
Name:LAPORTE, ROLAND ANDRE JR
Entity type:Individual
Prefix:
First Name:ROLAND
Middle Name:ANDRE
Last Name:LAPORTE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MAST RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-1133
Mailing Address - Country:US
Mailing Address - Phone:603-626-4776
Mailing Address - Fax:603-626-4899
Practice Address - Street 1:605 MAST RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-1133
Practice Address - Country:US
Practice Address - Phone:603-626-4776
Practice Address - Fax:603-626-4899
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13752183500000X
NHR0837183500000X
MA17438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist