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General NPI Number Information
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NPI Number | 1407649460
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Entity Type | Individual
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Provider Name | TELL D SACKETT CPHT-ADV
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Gender | Male
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 593 EDDY ST
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City | PROVIDENCE
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State | RI
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Zip | 02903-4923
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Country | US
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Telephone | 401-444-3699
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Fax |
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Provider Business Mailing Address
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Address Line | 14 GEORGIANA DR
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City | CUMBERLAND
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State | RI
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Zip | 02864-1106
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PH202862
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License Number State | RI
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