Healthcare Provider Details

I. General information

NPI: 1437282886
Provider Name (Legal Business Name): PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SANDY BOTTOM RD
COVENTRY RI
02816-5863
US

IV. Provider business mailing address

85 SANDY BOTTOM RD
COVENTRY RI
02816-5863
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-0600
  • Fax: 401-823-7558
Mailing address:
  • Phone: 401-821-0600
  • Fax: 401-823-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHA00010
License Number StateRI

VIII. Authorized Official

Name: MR. MARK GILMORE
Title or Position: DIRECTOR OF OPERATIONS
Credential: RPH
Phone: 401-821-0600