Provider Demographics
NPI:1962055004
Name:PRIME HEALTHCARE SERVICES - LANDMARK ,LLC
Entity type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - LANDMARK ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KWUN HEUN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:401-769-4100
Mailing Address - Street 1:115 CASS AVE
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4731
Mailing Address - Country:US
Mailing Address - Phone:401-769-4100
Mailing Address - Fax:401-767-1636
Practice Address - Street 1:115 CASS AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4731
Practice Address - Country:US
Practice Address - Phone:401-769-4100
Practice Address - Fax:401-767-1636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERVICES - LANDMARK ,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-18
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy