Provider Demographics
NPI:1518251016
Name:BOUCHARD, RONALD P JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:P
Last Name:BOUCHARD
Suffix:JR
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 1:76 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2421
Mailing Address - Country:US
Mailing Address - Phone:401-816-5416
Mailing Address - Fax:
Practice Address - Street 1:1024 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2820
Practice Address - Country:US
Practice Address - Phone:508-672-0888
Practice Address - Fax:508-676-1864
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist