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General NPI Number Information
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NPI Number | 1982737649
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Entity Type | Organization
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Legal Business Name | PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 59 SANDY BOTTOM RD
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City | COVENTRY
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State | RI
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Zip | 02816-5863
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Country | US
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Telephone | 401-821-5000
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Fax | 401-821-5016
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Provider Business Mailing Address
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Address Line | 59 SANDY BOTTOM RD
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City | COVENTRY
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State | RI
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Zip | 02816-5863
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Country | US
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Telephone | 401-821-5000
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Fax | 401-821-5016
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MARK GILMORE
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Credential | RPH
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Telephone | 401-821-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHA00001
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License Number State | RI
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