Provider Demographics
NPI:1184731879
Name:CHEPACHET PHARMACY, INC.
Entity type:Organization
Organization Name:CHEPACHET PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD
Authorized Official - Phone:401-568-2536
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:15 MONEY HILL RD
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-0901
Mailing Address - Country:US
Mailing Address - Phone:401-568-2536
Mailing Address - Fax:401-568-2563
Practice Address - Street 1:15 MONEY HILL RD
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-0901
Practice Address - Country:US
Practice Address - Phone:401-568-2536
Practice Address - Fax:401-568-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPHA001153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4100501OtherNABP PROVIDER NUMBER
RI9010115Medicaid
RI9010115Medicaid