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General NPI Number Information
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NPI Number | 1366578775
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Entity Type | Organization
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Legal Business Name | FAIRLAWN PHARMACY INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 582 SMITHFIELD AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-1633
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Country | US
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Telephone | 401-723-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 582 SMITHFIELD AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-1633
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BEDROS KOOSHERIAN
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Credential | RPH
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Telephone | 401-723-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | PHA00067
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License Number State | RI
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