Provider Demographics
NPI:1124031562
Name:MUSGRAVE INC
Entity Type:Organization
Organization Name:MUSGRAVE INC
Other - Org Name:WELLINGTON SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:BS RPH
Authorized Official - Phone:401-846-1296
Mailing Address - Street 1:580 THAMES ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-6741
Mailing Address - Country:US
Mailing Address - Phone:401-846-1296
Mailing Address - Fax:401-848-5538
Practice Address - Street 1:580 THAMES ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-6741
Practice Address - Country:US
Practice Address - Phone:401-846-1296
Practice Address - Fax:401-848-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPHA00154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4101135OtherNABP
RIWS00100Medicaid
RIBM0324791OtherDEA