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General NPI Number Information
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NPI Number | 1215353586
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Entity Type | Organization
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Legal Business Name | PHUSION RX #102, LLC
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 42 LADD ST UNIT #208
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City | EAST GREENWICH
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State | RI
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Zip | 02818-4361
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Country | US
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Telephone | 855-748-7466
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Fax |
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Provider Business Mailing Address
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Address Line | 42 LADD ST UNIT #208
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City | EAST GREENWICH
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State | RI
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Zip | 02818-4361
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Country | US
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Telephone | 855-748-7466
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Fax |
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | DR. DAVID CHARLES HUGHES
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Credential | PHARM.D.
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Telephone | 855-748-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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