Healthcare Provider Details

I. General information

NPI: 1174412209
Provider Name (Legal Business Name): KATELYN CHOINIERE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CHAPMAN ST
PROVIDENCE RI
02905-5400
US

IV. Provider business mailing address

20 BRADFORD DR
LINCOLN RI
02865-2319
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-9909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH06675
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: