Healthcare Provider Details

I. General information

NPI: 1528144128
Provider Name (Legal Business Name): GENTER'S PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 BROAD ST
PROVIDENCE RI
02907-1724
US

IV. Provider business mailing address

866 BROAD ST
PROVIDENCE RI
02907-1724
US

V. Phone/Fax

Practice location:
  • Phone: 401-941-5698
  • Fax: 401-785-3399
Mailing address:
  • Phone: 401-941-5698
  • Fax: 401-785-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number342001
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number104
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateRI

VIII. Authorized Official

Name: JOSEPH GOODMAN
Title or Position: SEC/TREAS
Credential: R,PH.
Phone: 401-941-5698