Provider Demographics
NPI:1932344587
Name:POLICELLI, GINA MARIE (RPH, AE-C)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:POLICELLI
Suffix:
Gender:F
Credentials:RPH, AE-C
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:POLICELLI-HALVORSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH, AE-C
Mailing Address - Street 1:89 EDWARD RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2720
Mailing Address - Country:US
Mailing Address - Phone:401-739-4330
Mailing Address - Fax:401-732-8316
Practice Address - Street 1:198 BUTTONWOODS AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7541
Practice Address - Country:US
Practice Address - Phone:401-739-4330
Practice Address - Fax:491-732-8316
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist