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General NPI Number Information
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NPI Number | 1003561655
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Entity Type | Organization
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Legal Business Name | AJ PHARMACY STORE 02
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Dates
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Enumeration Date | 02/12/2022
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 468 SMITHFIELD RD
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4266
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Country | US
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Telephone | 401-366-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 SMITH ST
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City | PROVIDENCE
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State | RI
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Zip | 02908-2747
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Country | US
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Telephone | 401-366-2800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES AGWUNOBI
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Credential |
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Telephone | 401-499-5427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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