Provider Demographics
NPI:1013018613
Name:MCQUADES MARKET PLACE PHARMACY INC
Entity Type:Organization
Organization Name:MCQUADES MARKET PLACE PHARMACY INC
Other - Org Name:MCQUADE MARKET PLACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-596-0277
Mailing Address - Street 1:106 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2114
Mailing Address - Country:US
Mailing Address - Phone:401-596-0277
Mailing Address - Fax:401-596-5461
Practice Address - Street 1:106 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2114
Practice Address - Country:US
Practice Address - Phone:401-596-0277
Practice Address - Fax:401-596-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPHA000213336C0003X, 332B00000X
RI3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMP00252Medicaid
RIMP00253Medicaid
2088724OtherPK
RIMP00252Medicaid