Healthcare Provider Details

I. General information

NPI: 1215353586
Provider Name (Legal Business Name): PHUSION RX #102, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 LADD ST UNIT #208
EAST GREENWICH RI
02818-4361
US

IV. Provider business mailing address

42 LADD ST UNIT #208
EAST GREENWICH RI
02818-4361
US

V. Phone/Fax

Practice location:
  • Phone: 855-748-7466
  • Fax:
Mailing address:
  • Phone: 855-748-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID CHARLES HUGHES
Title or Position: CEO & PRESIDENT
Credential: PHARM.D.
Phone: 855-748-7466