Provider Demographics
NPI:1255900775
Name:PARISEAU, ANDREA JEAN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:PARISEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 WILLETT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2037
Mailing Address - Country:US
Mailing Address - Phone:401-433-5710
Mailing Address - Fax:401-433-5713
Practice Address - Street 1:1066 WILLETT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2037
Practice Address - Country:US
Practice Address - Phone:401-433-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-19
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist