# PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER,INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pawtuxet Valley Long Term Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437282803
- **Authorized official:** MARK GILMORE RPH (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (401) 821-0600

## Contact information

- **Practice address:** 65 SANDY BOTTOM RD, COVENTRY, RI 02816-5863
- **Practice address phone:** (401) 823-9400
- **Practice address fax:** (410) 822-0262
- **Mailing address:** 65 SANDY BOTTOM RD, COVENTRY, RI 02816-5863
- **Mailing address phone:** (401) 823-9400
- **Mailing address fax:** (410) 822-0262

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | PHA00001 | RI | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4103406 | NCPDP | RI |
| 01 | — | PHA00001 | LICENSE \# | RI |