Healthcare Provider Details

I. General information

NPI: 1427041177
Provider Name (Legal Business Name): CHRIS J MAXWELL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

111 JULIA ST
CRANSTON RI
02910-1840
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-6316
  • Fax:
Mailing address:
  • Phone: 401-785-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2693
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: