Provider Demographics
NPI:1255416541
Name:QUALITY PHARMACEUTICAL SERVICES
Entity type:Organization
Organization Name:QUALITY PHARMACEUTICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:UUSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-294-1332
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:SAUNDERSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02874-0115
Mailing Address - Country:US
Mailing Address - Phone:401-294-1332
Mailing Address - Fax:401-294-0801
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:STE F101
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-294-1332
Practice Address - Fax:401-294-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPHA002803336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIQP44466Medicaid
4106109OtherNCPDP PROVIDER IDENTIFICATION NUMBER