NPIMap

Organization Active NPI

Pawtuxet Valley Prescription & Surgical Center,Inc

  • Long Term Care Pharmacy
  • Coventry, RI
National Provider Identifier
1437282803
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHA00001 Issued in RI
Legal business name
PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC
Practice address
65 Sandy Bottom Rd
Coventry, RI 02816-5863
Phone
(401) 823-9400
Fax
(410) 822-0262
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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
Long Term Care Pharmacy 3336L0003X PHA00001 RI Primary

Addresses

Primary practice location

65 Sandy Bottom Rd
Coventry, RI 02816-5863

Mailing address

65 Sandy Bottom Rd
Coventry, RI 02816-5863
Phone (401) 823-9400

Other identifiers 2

IdentifierTypeStateIssuer
4103406OtherRINCPDP
PHA00001OtherRILICENSE #

Other names 1

  • Pawtuxet Valley Long Term Care 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.

Locations

65 Sandy Bottom Rd
Coventry, RI 02816
Phone (401) 823-9400

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": "1678147200000",
    "number": "1437282803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 SANDY BOTTOM RD",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028165863",
            "telephone_number": "401-823-9400",
            "fax_number": "410-822-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 SANDY BOTTOM RD",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028165863",
            "telephone_number": "401-823-9400",
            "fax_number": "410-822-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2023-03-07",
        "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": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "RI",
            "license": "PHA00001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4103406",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "PHA00001",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pawtuxet Valley Long Term Care",
            "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 Mar 7, 2023; 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.