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General NPI Number Information
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NPI Number | 1609306919
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Entity Type | Organization
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Legal Business Name | CCR PHARMACY LLC
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1165 MAIN AVE
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City | WARWICK
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State | RI
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Zip | 02886-1940
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Country | US
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Telephone | 401-861-1194
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Fax | 401-383-7773
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Provider Business Mailing Address
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Address Line | 1165 MAIN AVE
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City | WARWICK
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State | RI
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Zip | 02886-1940
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Country | US
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Telephone | 401-861-1194
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Fax | 401-383-7773
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | PAUL CAPUANO
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Credential |
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Telephone | 401-861-1194
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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 | 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 #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHA00542
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License Number State | RI
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