Aj Pharmacy Store 02

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

AJ PHARMACY STORE 02

Practice address

468 Smithfield Rd
North Providence, RI 02904-4266

Phone

(401) 366-2800

NPI assigned

Feb 12, 2022

Organization subpart

Yes

Parent organization

AJ PHARMACY LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles AgwunobiNPI 1851926364

Title

Owner

Phone

(401) 499-5427

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• AJ Pharmacy store 02 Doing business as
• AJ pharmacy/convenience store Doing business as

Electronic endpoints 2

Part of

Aj Pharmacy LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Aj Pharmacy LLC

  • Pharmacy
  • Providence, RI
  • NPI 1386270601
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Agwunobi

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Providence, RI
  • NPI 1851926364
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1003561655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 SMITH ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029082747",
            "telephone_number": "401-366-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "468 SMITHFIELD RD",
            "city": "NORTH PROVIDENCE",
            "state": "RI",
            "postal_code": "029044266",
            "telephone_number": "401-366-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AJ PHARMACY STORE 02",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AJ PHARMACY LLC",
        "enumeration_date": "2022-02-12",
        "last_updated": "2022-09-08",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "AGWUNOBI",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-499-5427"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Pioneerrx",
            "affiliation": "N",
            "endpointDescription": "Pioneerrx",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "468 Smithfield Rd",
            "city": "North Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029044266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Pioneerrx",
            "affiliation": "N",
            "endpointDescription": "Cloud messaging",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "468 Smithfield Rd",
            "city": "North Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029044266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "AJ Pharmacy store 02",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AJ Pharmacy store 02",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AJ pharmacy/convenience store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in North Providence, RI
• Community/Retail Pharmacy in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.