Healthcare Provider Details

I. General information

NPI: 1710277355
Provider Name (Legal Business Name): JESSICA REALL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CHAPMAN ST STE 200
PROVIDENCE RI
02905-5400
US

IV. Provider business mailing address

179 POMONA ST
NORTH SMITHFIELD RI
02896-8181
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-9909
  • Fax: 401-444-4095
Mailing address:
  • Phone: 401-597-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number4151
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: