Healthcare Provider Details

I. General information

NPI: 1184731879
Provider Name (Legal Business Name): CHEPACHET PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MONEY HILL RD
CHEPACHET RI
02814-0901
US

IV. Provider business mailing address

PO BOX 702 15 MONEY HILL RD
CHEPACHET RI
02814-0901
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-2536
  • Fax: 401-568-2563
Mailing address:
  • Phone: 401-568-2536
  • Fax: 401-568-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA00115
License Number StateRI

VIII. Authorized Official

Name: DR. CRAIG A BOWEN
Title or Position: PHARMACIST IN CHARGE
Credential: RPH, PHARM.D.
Phone: 401-568-2536