=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932344587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GINA MARIE POLICELLI RPH., AE-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2008
-----------------------------------------------------
Last Update Date | 12/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 198 BUTTONWOODS AVE
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-7541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-739-4330
-----------------------------------------------------
Fax | 491-732-8316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 89 EDWARD RD
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-739-4330
-----------------------------------------------------
Fax | 401-732-8316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 3867
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------