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General NPI Number Information
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NPI Number | 1710277355
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Entity Type | Individual
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Provider Name | JESSICA REALL RPH
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Gender | Female
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Dates
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Enumeration Date | 04/16/2011
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 117 CHAPMAN ST STE 200
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City | PROVIDENCE
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State | RI
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Zip | 02905-5400
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Country | US
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Telephone | 401-444-9909
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Fax | 401-444-4095
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Provider Business Mailing Address
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Address Line | 179 POMONA ST
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City | NORTH SMITHFIELD
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State | RI
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Zip | 02896-8181
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Country | US
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Telephone | 401-597-5810
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 4151
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License Number State | RI
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