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Organization
FAIRLAWN PHARMACY INC
Active
Organization
FAIRLAWN PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEDROS KOOSHERIAN RPH (PRESIDENT)
(401) 723-8070
Entity
Organization
Contact information
Practice address
582 SMITHFIELD AVE, PAWTUCKET, RI 02860-1633
(401) 723-8070
Mailing address
582 SMITHFIELD AVE, PAWTUCKET, RI 02860-1633
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHA00067
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4101286
OTHER ID NUMBER
—
05
—
FP00779
—
RI
Enumeration date
02/27/2007
Last updated
09/12/2007
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