Jamie Lynn McCrillis, RPH

Key facts

NPI

1134722333

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

RPH04112 (RI)

Practice address

20 High St
Pascoag, RI 02859-2619

Phone

(401) 568-4224

Fax

(401) 568-6982

NPI assigned

Nov 19, 2020

Sex

Female

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rhode Island CVS Pharmacy LLC Pharmacy · North Kingstown, RI · NPI 1063037059
  NPD (past)
• Rhode Island CVS Pharmacy, L.L.C. Pharmacy · Pascoag, RI · NPI 1194829994
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Pharmacist

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 19, 2020.

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1134722333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 FEDERAL WAY APT 303",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029194680",
            "telephone_number": "401-595-6497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 HIGH ST",
            "city": "PASCOAG",
            "state": "RI",
            "postal_code": "028592619",
            "telephone_number": "401-568-4224",
            "fax_number": "401-568-6982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCRILLIS",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "RI",
            "license": "RPH04112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Pascoag, RI · Pharmacist in Rhode Island