Healthcare Provider Details

I. General information

NPI: 1508579418
Provider Name (Legal Business Name): AUDREY ELIZABETH WHALEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 WILLETT AVE
RIVERSIDE RI
02915-2067
US

IV. Provider business mailing address

102 MOUNT VIEW RD
NARRAGANSETT RI
02882-1657
US

V. Phone/Fax

Practice location:
  • Phone: 401-433-5710
  • Fax: 401-433-5713
Mailing address:
  • Phone: 401-741-1585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH06467
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: