Healthcare Provider Details

I. General information

NPI: 1659393619
Provider Name (Legal Business Name): MARLENE ICAY CALLAHAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

525 IRON MINE HILL RD
NORTH SMITHFIELD RI
02896-8157
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax: 401-525-2564
Mailing address:
  • Phone: 401-766-1728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH03174
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH03174
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: