NPIMap

Organization Active NPI

Brown University of Provedence State of Ri and Prov Plantaio

  • Community/Retail Pharmacy
  • Providence, RI
National Provider Identifier
1629013149
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
BROWN UNIVERSITY OF PROVEDENCE STATE OF RI AND PROV PLANTAIO
Practice address
450 Brook Street
Providence, RI 02912-9006
Phone
(401) 863-7882
Fax
(401) 863-2178
NPI assigned
Jun 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Authorized official

Name
Paul BergeronNPI 1407901440
Title
Director of Pharmacy
Phone
(401) 863-7882

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

450 Brook Street
Providence, RI 02912-9006

Mailing address

13 Brown St
Providence, RI 02912-9006
Phone (401) 863-7882

Other identifiers 1

IdentifierTypeStateIssuer
2088775OtherPK

Other names 1

  • BROWN UNIVERSITY STUDENT HEALTH CENTER PHARMACY Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address paul_bergeron@brown.edu

National Provider Directory

National Provider Directory
Tax ID family
Brown University Health Services Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

13 Brown St
Providence, RI 02912
Phone (401) 863-3953

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1629013149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 BROWN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029129006",
            "telephone_number": "401-863-7882",
            "fax_number": "401-863-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 BROOK STREET",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029129006",
            "telephone_number": "401-863-7882",
            "fax_number": "401-863-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROWN UNIVERSITY OF PROVEDENCE STATE OF RI AND PROV PLANTAIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "BERGERON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "401-863-7882"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2088775",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "paul_bergeron@brown.edu",
            "affiliation": "N",
            "address_1": "450 Brook Street",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029129006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BROWN UNIVERSITY STUDENT HEALTH CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BROWN UNIVERSITY STUDENT HEALTH CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.