Healthcare Provider Details

I. General information

NPI: 1649608696
Provider Name (Legal Business Name): PRESCRIPTION COMPOUNDING SPECIALISTS OF RI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 RESERVOIR AVE SUITE 116
CRANSTON RI
02920-6055
US

IV. Provider business mailing address

1145 RESERVOIR AVE SUITE 116
CRANSTON RI
02920-6055
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 Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHA00553
License Number StateRI

VIII. Authorized Official

Name: MRS. ANNMARIE THERESA ARVANITES
Title or Position: OWNER/VICE PRESIDENT
Credential: RPH
Phone: 401-429-0330