Provider Demographics
NPI:1619217502
Name:MEDICATION MANAGEMENT LLC
Entity Type:Organization
Organization Name:MEDICATION MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:508-369-9888
Mailing Address - Street 1:71 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3615
Mailing Address - Country:US
Mailing Address - Phone:508-369-9888
Mailing Address - Fax:
Practice Address - Street 1:600 PUTNAM PIKE
Practice Address - Street 2:SUITE 7
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1486
Practice Address - Country:US
Practice Address - Phone:401-949-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37242261QH0100X
RIRN40329261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service