Organization
EAST SIDE PRESCRIPTION CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD E BACKER R.PH. (PRES)
(401) 751-1430
Entity
Organization
Contact information
Practice address
632 HOPE ST, PROVIDENCE, RI 02906-2658
(401) 751-1430
(401) 454-8096
Mailing address
632 HOPE ST, PROVIDENCE, RI 02906-2658
(401) 751-1430
(401) 454-8096
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
ES04467
RI
3336C0003X
Community/Retail Pharmacy
Primary
209
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4102961
NCPDP
—
05
—
9010209
—
RI
05
—
ES04467
—
RI
Enumeration date
06/19/2006
Last updated
01/20/2009
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