Healthcare Provider Details

I. General information

NPI: 1134033103
Provider Name (Legal Business Name): PRESCRIPTION COMPOUNDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 RESERVOIR AVE STE 116
CRANSTON RI
02920-6000
US

IV. Provider business mailing address

1145 RESERVOIR AVE STE 116
CRANSTON RI
02920-6000
US

V. Phone/Fax

Practice location:
  • Phone: 401-429-0330
  • Fax: 401-429-0333
Mailing address:
  • Phone: 401-429-0330
  • Fax: 401-429-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELIZABETH MARY DELVECCHIO DOIDGE
Title or Position: OWNER
Credential: PHARMD, BCPS
Phone: 401-374-4900