Provider Demographics
NPI:1154822559
Name:VAN EEGHENS PHARMACY LLC
Entity Type:Organization
Organization Name:VAN EEGHENS PHARMACY LLC
Other - Org Name:VAN EEGHEN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN EEGHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-741-7738
Mailing Address - Street 1:650 OAKLAWN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2811
Mailing Address - Country:US
Mailing Address - Phone:401-741-7738
Mailing Address - Fax:401-741-7738
Practice Address - Street 1:650 OAKLAWN AVE STE E
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2811
Practice Address - Country:US
Practice Address - Phone:401-741-7738
Practice Address - Fax:401-741-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPHA0065333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176145OtherPK