Healthcare Provider Details

I. General information

NPI: 1962055004
Provider Name (Legal Business Name): PRIME HEALTHCARE SERVICES - LANDMARK ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CASS AVE
WOONSOCKET RI
02895-4731
US

IV. Provider business mailing address

115 CASS AVE OUTPATIENT PHARMACY
WOONSOCKET RI
02895-4731
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-4100
  • Fax: 401-767-1636
Mailing address:
  • Phone: 401-769-4100
  • Fax: 401-767-1636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KWUN HEUN BRIAN LEUNG
Title or Position: PHARMACY SUPERVISOR
Credential: RPH
Phone: 401-769-4100