Individual
JACOB DERBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
204 GARFIELD AVE, CRANSTON, RI 02920-7803
(401) 943-8285
Mailing address
204 GARFIELD AVE, CRANSTON, RI 02920-7803
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH06886
RI
183700000X
Pharmacy Technician
Primary
PHL06062
RI
Other
Enumeration date
02/03/2026
Last updated
07/20/2026
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