Provider Demographics
NPI:1174805840
Name:BEAURIVAGE, NADIA (PHARMD, RPH)
Entity type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:
Last Name:BEAURIVAGE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SANBORN RD
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276-5725
Mailing Address - Country:US
Mailing Address - Phone:603-286-1932
Mailing Address - Fax:603-286-1938
Practice Address - Street 1:4 SANBORN RD
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5725
Practice Address - Country:US
Practice Address - Phone:603-286-1932
Practice Address - Fax:603-286-1938
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist