1033145818 NPI number — ELEANOR SLATER HOSPITAL PHARMACY

Table of content: (NPI 1033145818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033145818 NPI number — ELEANOR SLATER HOSPITAL PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEANOR SLATER HOSPITAL PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELEANOR SLATER PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033145818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 HOWARD AVE
Provider Second Line Business Mailing Address:
MATHIAS BUILDING
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02920-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-462-3077
Provider Business Mailing Address Fax Number:
401-462-0974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 HOWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02920-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-462-3077
Provider Business Practice Location Address Fax Number:
401-462-0974
Provider Enumeration Date:
06/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOPKINS
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR OF PHARMACY SVS
Authorized Official Telephone Number:
401-462-3077

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PHB00026 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2088790 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4102001 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".