Provider Demographics
NPI:1316490618
Name:BOSEKE, JESSIE ANH (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:ANH
Last Name:BOSEKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:ANH
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:92 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2307
Mailing Address - Country:US
Mailing Address - Phone:603-781-4865
Mailing Address - Fax:
Practice Address - Street 1:271 MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4124
Practice Address - Country:US
Practice Address - Phone:603-781-4865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist