NPIMap

Organization Active NPI

Pawtuxet Valley Prescription & Surgical Center,Inc

  • Compounding Pharmacy
  • Coventry, RI
National Provider Identifier
1043343411
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
License
PHA00001 Issued in RI
Legal business name
PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC
Practice address
59 Sandy Bottom Rd
Coventry, RI 02816-5863
Phone
(401) 821-5000
Fax
(401) 821-5016
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mark Gilmore, RPH
Title
Director of Operations
Phone
(401) 821-0600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X PHA00001 RI Primary

Addresses

Primary practice location

59 Sandy Bottom Rd
Coventry, RI 02816-5863

Mailing address

59 Sandy Bottom Rd
Coventry, RI 02816-5863
Phone (401) 821-5000

Other identifiers 2

IdentifierTypeStateIssuer
PHA00001OtherRILICENSE #
4103406OtherRINCPDP

Other names 1

  • Pawtuxet Valley Compound Lab Other name

National Provider Directory

National Provider Directory
Tax ID family
Pawtuxet Valley Compound Lab5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043343411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 SANDY BOTTOM RD",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028165863",
            "telephone_number": "401-821-5000",
            "fax_number": "401-821-5016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 SANDY BOTTOM RD",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028165863",
            "telephone_number": "401-821-5000",
            "fax_number": "401-821-5016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GILMORE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "401-821-0600",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "RI",
            "license": "PHA00001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "PHA00001",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4103406",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pawtuxet Valley Compound Lab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coventry, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.