Healthcare Provider Details

I. General information

NPI: 1104422278
Provider Name (Legal Business Name): VICTORIA SOUZA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ADMIRAL ST
PROVIDENCE RI
02908-2416
US

IV. Provider business mailing address

50 PIAVE ST
PAWTUCKET RI
02860-4720
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-5030
  • Fax:
Mailing address:
  • Phone: 401-282-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH06163
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: