Healthcare Provider Details

I. General information

NPI: 1992814941
Provider Name (Legal Business Name): ROBERT LOUIS DUFRESNE R.PH. PHD, BCPP,BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROVIDENCE VA MEDICAL CTR 830 CHALKSTONE AVE
PROVIDENCE RI
02918-0001
US

IV. Provider business mailing address

41 LOWER COLLEGE RD
KINGSTON RI
02881-1966
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 401-397-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number2677
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: