Provider Demographics
NPI:1992814941
Name:DUFRESNE, ROBERT LOUIS (RPH PHD, BCPP,BCPS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:DUFRESNE
Suffix:
Gender:M
Credentials:RPH PHD, BCPP,BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LOWER COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1966
Mailing Address - Country:US
Mailing Address - Phone:401-397-1880
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE VA MEDICAL CTR
Practice Address - Street 2:830 CHALKSTONE AVE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02918-0001
Practice Address - Country:US
Practice Address - Phone:401-273-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI26771835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric