Provider Demographics
NPI:1225388341
Name:WYNNE, EILEEN LOWNEY
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:LOWNEY
Last Name:WYNNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 MERRYMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-5545
Mailing Address - Country:US
Mailing Address - Phone:401-463-5004
Mailing Address - Fax:
Practice Address - Street 1:620 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4293
Practice Address - Country:US
Practice Address - Phone:401-642-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist