Healthcare Provider Details

I. General information

NPI: 1114527181
Provider Name (Legal Business Name): COLETTE BISSONNETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 POST RD
WESTERLY RI
02891-2630
US

IV. Provider business mailing address

258 POST RD
WESTERLY RI
02891-2630
US

V. Phone/Fax

Practice location:
  • Phone: 401-322-0793
  • Fax:
Mailing address:
  • Phone: 401-322-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3264
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: