Healthcare Provider Details

I. General information

NPI: 1386270601
Provider Name (Legal Business Name): AJ PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 SMITH ST
PROVIDENCE RI
02908-2747
US

IV. Provider business mailing address

1017 SMITH ST
PROVIDENCE RI
02908-2747
US

V. Phone/Fax

Practice location:
  • Phone: 401-499-5427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES AGWUNOBI
Title or Position: OWNER/PHARMACIST MANAGER
Credential: PHARMD
Phone: 401-499-5427