PROVIDENCE PHARMACY (2875)    INSTITUTION (4)

Name Value
NAME PROVIDENCE PHARMACY
STATE RHODE ISLAND
STREET ADDR. 1 830 CHALKSTONE AVE
CITY PROVIDENCE
ZIP 02908-4734
OFFICIAL VA NAME Providence Pharmacy
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME PROVIDENCE VAMC PHARMACY
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1619935145
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
HISTORY
  • STREET ADDR. 1 (CHANGED FROM):   830 Chalkstone Ave.
    CITY (CHANGED FROM):   Providence
    STATE (CHANGED FROM):   RHODE ISLAND
    ZIP (CHANGED FROM):   02908-4734
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1619935145