Healthcare Provider Details

I. General information

NPI: 1639444953
Provider Name (Legal Business Name): RAYMOND E CIARLEGLIO JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-4003
US

IV. Provider business mailing address

97 SOUTHWINDS DR
WAKEFIELD RI
02879-1638
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-3113
  • Fax:
Mailing address:
  • Phone: 401-413-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH03241
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: