Provider Demographics
NPI:1033705645
Name:BERGANTINO, LOUIS ANTHONY III (RPH)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:ANTHONY
Last Name:BERGANTINO
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4053
Mailing Address - Country:US
Mailing Address - Phone:401-944-2669
Mailing Address - Fax:
Practice Address - Street 1:200 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4053
Practice Address - Country:US
Practice Address - Phone:401-944-2669
Practice Address - Fax:401-944-8506
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist