MEDICARE: MISS MICHAEL ANTHONY IAFRATE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH05350	RI

General Provider Information

NPI Number	:	1356750491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHAEL ANTHONY IAFRATE PHARMD

Provider Business Mailing Address
First Line	:	79 STILLWATER AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02908-1126
Country	:	US
Telephone Number	:	401-644-5292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 SMITH ST
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02911-2918
Country	:	US
Telephone Number	:	401-353-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2014
Last Update Date	:	08/02/2014

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