Provider Demographics
NPI:1295017077
Name:PEDRO, HENRIQUE T (RPH)
Entity Type:Individual
Prefix:MR
First Name:HENRIQUE
Middle Name:T
Last Name:PEDRO
Suffix:
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 1:1279 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2652
Mailing Address - Country:US
Mailing Address - Phone:401-463-8039
Mailing Address - Fax:401-863-8075
Practice Address - Street 1:1279 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2652
Practice Address - Country:US
Practice Address - Phone:401-463-8039
Practice Address - Fax:401-863-8075
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH02308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist