Healthcare Provider Details

I. General information

NPI: 1629791520
Provider Name (Legal Business Name): BENJAMIN NICHOLAS SKOV RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 BOSTON NECK RD
NARRAGANSETT RI
02882-1734
US

IV. Provider business mailing address

1123 BOSTON NECK RD
NARRAGANSETT RI
02882-1734
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-1753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH05874
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: