Healthcare Provider Details

I. General information

NPI: 1508971870
Provider Name (Legal Business Name): BENJAMIN JAMES PENNINGTON R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

330 RED CHIMNEY DR
WARWICK RI
02886-9321
US

V. Phone/Fax

Practice location:
  • Phone: 401-457-3048
  • Fax:
Mailing address:
  • Phone: 401-457-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2342
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: