Gordon Bennett Jr.
Individual provider Active NPI Pharmacist · Derry, NH
NPI 1710108360 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1710108360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 1850 (NH)
- Practice address
- 20 Crystal Ave
Derry, NH 03038-2412 - Phone
- (603) 437-9799
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1850 | NH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maxi Drug North Inc | Past | Accepting new patients | |
| Maxi Drug North Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 1850 | NH | Yes |
Addresses
Primary practice location
20 Crystal Ave
Derry, NH 03038-2412
Mailing address
54 Lawrence Rd
Derry, NH 03038-4191
Phone (603) 432-5109
Other providers in Derry, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.