Provider Demographics
NPI:1386957900
Name:GAGNE, GERARD ROGER (RPH)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:ROGER
Last Name:GAGNE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-2028
Mailing Address - Country:US
Mailing Address - Phone:603-934-6862
Mailing Address - Fax:603-934-2093
Practice Address - Street 1:951 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2028
Practice Address - Country:US
Practice Address - Phone:603-934-6862
Practice Address - Fax:603-934-2093
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist