Healthcare Provider Details

I. General information

NPI: 1205747359
Provider Name (Legal Business Name): MS. NICOLE ELIZABETH PERREAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 MAIN ST
WEST WARWICK RI
02893-4808
US

IV. Provider business mailing address

210 YEOMAN AVE
CRANSTON RI
02920-2232
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-2762
  • Fax:
Mailing address:
  • Phone: 401-822-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH06922
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: