Provider Demographics
NPI:1689814949
Name:BRUNELLE, NICHOLAS G (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:G
Last Name:BRUNELLE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-3054
Mailing Address - Country:US
Mailing Address - Phone:401-949-1848
Mailing Address - Fax:401-949-1539
Practice Address - Street 1:446 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-3054
Practice Address - Country:US
Practice Address - Phone:401-949-1848
Practice Address - Fax:401-949-1539
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05206183500000X
MA26383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist