Provider Demographics
NPI:1174621189
Name:SJ PHYSICIAN SERVICES, INC DBA NASHUA MEDICAL GROUP PHARMACY
Entity type:Organization
Organization Name:SJ PHYSICIAN SERVICES, INC DBA NASHUA MEDICAL GROUP PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PLAMONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-598-3352
Mailing Address - Street 1:PO BOX 95000 LBX 7655
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:207-777-8202
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:173 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5224
Practice Address - Country:US
Practice Address - Phone:603-891-4439
Practice Address - Fax:603-891-4410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SJ PHYSICIAN SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH068713336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3060821OtherNCPDP NUMBER