Provider Demographics
NPI:1952903726
Name:PACHECO, AVERY (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 STONEY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2731
Mailing Address - Country:US
Mailing Address - Phone:401-297-1858
Mailing Address - Fax:
Practice Address - Street 1:181 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3989
Practice Address - Country:US
Practice Address - Phone:401-846-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist