Provider Demographics
NPI:1194220087
Name:RICCI, RENATA GRAYCE (RPH)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:GRAYCE
Last Name:RICCI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:RENATA
Other - Middle Name:GRAYCE
Other - Last Name:RICCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:980 CARRS POND RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:980 CARRS POND RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1041
Practice Address - Country:US
Practice Address - Phone:401-345-3164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist