Healthcare Provider Details

I. General information

NPI: 1144556770
Provider Name (Legal Business Name): MPS RX NEW ENGLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33B APPIAN WAY
SMITHFIELD RI
02917-1777
US

IV. Provider business mailing address

100 E KENSINGER DR SUITE 500
CRANBERRY TOWNSHIP PA
16066-3556
US

V. Phone/Fax

Practice location:
  • Phone: 724-940-2490
  • Fax: 877-295-7772
Mailing address:
  • Phone: 866-466-7779
  • Fax: 877-295-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHA00516
License Number StateRI

VIII. Authorized Official

Name: RON MCKILLIP
Title or Position: VP, BUSINESS SYSTEMS SUPPORT
Credential:
Phone: 724-940-2819