Provider Demographics
NPI:1821647322
Name:GERUNDIO, ALYSSA RAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:RAE
Last Name:GERUNDIO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3740
Mailing Address - Country:US
Mailing Address - Phone:401-256-8323
Mailing Address - Fax:
Practice Address - Street 1:1387 PLAINFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-6821
Practice Address - Country:US
Practice Address - Phone:401-942-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist