Provider Demographics
NPI:1134722333
Name:MCCRILLIS, JAMIE LYNN (RPH)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:MCCRILLIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 FEDERAL WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4680
Mailing Address - Country:US
Mailing Address - Phone:401-595-6497
Mailing Address - Fax:
Practice Address - Street 1:20 HIGH ST
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-2619
Practice Address - Country:US
Practice Address - Phone:401-568-4224
Practice Address - Fax:401-568-6982
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist