Provider Demographics
NPI:1285971051
Name:EVSTIFEEV, VADIM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VADIM
Middle Name:
Last Name:EVSTIFEEV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PLAISTOW RD
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2831
Mailing Address - Country:US
Mailing Address - Phone:603-382-2844
Mailing Address - Fax:
Practice Address - Street 1:58 PLAISTOW RD
Practice Address - Street 2:
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-2831
Practice Address - Country:US
Practice Address - Phone:603-382-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27624183500000X
FLPS46972183500000X
NHPHCY-04586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist