Provider Demographics
NPI:1699271403
Name:RHODE ISLAND VETERANS HOME
Entity type:Organization
Organization Name:RHODE ISLAND VETERANS HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-253-8000
Mailing Address - Street 1:480 METACOM AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-5119
Mailing Address - Country:US
Mailing Address - Phone:401-253-8000
Mailing Address - Fax:401-396-8125
Practice Address - Street 1:480 METACOM AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-5119
Practice Address - Country:US
Practice Address - Phone:401-253-8000
Practice Address - Fax:401-396-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
RIPHB000293336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176705OtherPK