Provider Demographics
NPI:1972898781
Name:PERCIVAL, DARRYL L (RPH)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:L
Last Name:PERCIVAL
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 1:1080 BALD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4202
Mailing Address - Country:US
Mailing Address - Phone:401-822-0002
Mailing Address - Fax:401-822-0115
Practice Address - Street 1:1080 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4202
Practice Address - Country:US
Practice Address - Phone:401-822-0002
Practice Address - Fax:401-822-0115
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH-2336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist