Provider Demographics
NPI:1033145818
Name:ELEANOR SLATER HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:ELEANOR SLATER HOSPITAL PHARMACY
Other - Org Name:ELEANOR SLATER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR OF PHARMACY SVS
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:401-462-3077
Mailing Address - Street 1:111 HOWARD AVE
Mailing Address - Street 2:MATHIAS BUILDING
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3001
Mailing Address - Country:US
Mailing Address - Phone:401-462-3077
Mailing Address - Fax:401-462-0974
Practice Address - Street 1:111 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3001
Practice Address - Country:US
Practice Address - Phone:401-462-3077
Practice Address - Fax:401-462-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
RIPHB000263336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2088790OtherPK
RI4102001Medicaid