Healthcare Provider Details

I. General information

NPI: 1689964447
Provider Name (Legal Business Name): DAVID MICHAEL NARDOLILLO JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HARTFORD AVE
JOHNSTON RI
02919-3246
US

IV. Provider business mailing address

2109 HARTFORD AVE
JOHNSTON RI
02919-3246
US

V. Phone/Fax

Practice location:
  • Phone: 401-595-3387
  • Fax:
Mailing address:
  • Phone: 401-595-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49905
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04980
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: