Provider Demographics
NPI:1588742092
Name:PENACOOK PHARMACY LLC
Entity type:Organization
Organization Name:PENACOOK PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:TECH
Authorized Official - Phone:603-753-6391
Mailing Address - Street 1:305 VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:PENACOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03303-4508
Mailing Address - Country:US
Mailing Address - Phone:603-753-6391
Mailing Address - Fax:603-753-8664
Practice Address - Street 1:305 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:PENACOOK
Practice Address - State:NH
Practice Address - Zip Code:03303-4508
Practice Address - Country:US
Practice Address - Phone:603-753-6391
Practice Address - Fax:603-753-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NH01803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3000231OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NH3080329Medicaid
NH0610920001Medicare NSC