Healthcare Provider Details

I. General information

NPI: 1689016057
Provider Name (Legal Business Name): KRISTINA MARIE SOARES LAPERRIERE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 03/15/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST GEORGE BUILDING, 1ST FLOOR
PROVIDENCE RI
02903
US

IV. Provider business mailing address

593 EDDY ST GEORGE BUILDING, 1ST FLOOR
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5803
  • Fax: 401-444-0118
Mailing address:
  • Phone: 401-444-5803
  • Fax: 401-444-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234455
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH05534
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: