Healthcare Provider Details

I. General information

NPI: 1750665790
Provider Name (Legal Business Name): JOSEPH BELLUCCI III PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

100 BROAD ST
PAWTUCKET RI
02860-2024
US

IV. Provider business mailing address

100 BROAD ST
PAWTUCKET RI
02860-2024
US

V. Phone/Fax

Practice location:
  • Phone: 401-724-6724
  • Fax: 401-724-5649
Mailing address:
  • Phone: 401-724-6724
  • Fax: 401-724-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04854
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH232884
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: