Healthcare Provider Details

I. General information

NPI: 1134403496
Provider Name (Legal Business Name): ANGELICA ROSEMARY LUPO PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TARTAGLIA ST
JOHNSTON RI
02919-5929
US

IV. Provider business mailing address

5 TARTAGLIA ST
JOHNSTON RI
02919-5929
US

V. Phone/Fax

Practice location:
  • Phone: 401-946-1788
  • Fax:
Mailing address:
  • Phone: 401-946-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number05015
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: