Healthcare Provider Details

I. General information

NPI: 1174432942
Provider Name (Legal Business Name): MADISON ROSE MARCELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 TIOGUE AVE
COVENTRY RI
02816-5805
US

IV. Provider business mailing address

1 GRAY BIRCH DR
CRANSTON RI
02921-7509
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-2060
  • Fax:
Mailing address:
  • Phone: 401-474-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH06915
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: