Provider Demographics
NPI:1720721970
Name:VACCINE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:VACCINE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PELKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:401-585-3226
Mailing Address - Street 1:3595 POST RD APT 1105
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7000
Mailing Address - Country:US
Mailing Address - Phone:401-585-3226
Mailing Address - Fax:
Practice Address - Street 1:55 ITITCHING POST ROAD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:401-585-3226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1053051631OtherNPPES
MA1659422004Medicaid