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General NPI Number Information
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NPI Number | 1396787636
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Entity Type | Organization
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Legal Business Name | LASALLE PHARMACY,INC
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 113 PUTNAM PIKE
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City | JOHNSTON
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State | RI
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Zip | 02919-2047
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Country | US
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Telephone | 401-232-1194
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Fax |
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Provider Business Mailing Address
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Address Line | 113 PUTNAM PIKE
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City | JOHNSTON
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State | RI
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Zip | 02919-2047
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Country | US
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Telephone | 401-232-1194
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM J ROSA
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Credential | RPH
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Telephone | 401-232-1194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 02235
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License Number State | RI
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