Healthcare Provider Details

I. General information

NPI: 1972898781
Provider Name (Legal Business Name): DARRYL L PERCIVAL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 BALD HILL RD
WARWICK RI
02886-4202
US

IV. Provider business mailing address

1080 BALD HILL RD
WARWICK RI
02886-4202
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-0002
  • Fax: 401-822-0115
Mailing address:
  • Phone: 401-822-0002
  • Fax: 401-822-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-2336
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: