Healthcare Provider Details

I. General information

NPI: 1336840867
Provider Name (Legal Business Name): MEAV TAN AINLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/14/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHAPMAN ST STE 300
PROVIDENCE RI
02905-4539
US

IV. Provider business mailing address

245 CHAPMAN ST STE 300
PROVIDENCE RI
02905-4539
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-6320
  • Fax: 401-444-4445
Mailing address:
  • Phone: 401-606-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH3920
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH3920
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH3920
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: