Individual
DIANE MEDEIROS GOMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 455-6316
Mailing address
150 RYAN ST, NEW BEDFORD, MA 02740-1473
(774) 930-1564
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
25778
MA
183500000X
Pharmacist
RPH04561
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH04561
MA LICENSE
MA
Enumeration date
10/26/2020
Last updated
10/26/2020
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