=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477157634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD MICHAEL GUERNSEY PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2020
-----------------------------------------------------
Last Update Date | 11/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1054 CASS AVE
-----------------------------------------------------
City | WOONSOCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02895-4935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-767-3600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 PLEASANT VIEW AVE
-----------------------------------------------------
City | SMITHFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02917-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-816-3354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH05650
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------