=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720637226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCQUADE'S JAMESTOWN PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2019
-----------------------------------------------------
Last Update Date | 09/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 CLARKE ST
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-596-2054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CLARKE ST
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-596-2054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COURTNEY MCQUADE
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 401-596-2054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------