Healthcare Provider Details

I. General information

NPI: 1720678204
Provider Name (Legal Business Name): ANDREA OHAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 RESERVOIR AVE
CRANSTON RI
02910-3220
US

IV. Provider business mailing address

40 SOPHIA DR
CRANSTON RI
02921-3564
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-7186
  • Fax:
Mailing address:
  • Phone: 401-255-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH3404
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: