Provider Demographics
NPI:1245969278
Name:OTOOLE, KEVIN J II
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:OTOOLE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 GEORGE WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4293
Mailing Address - Country:US
Mailing Address - Phone:401-642-0081
Mailing Address - Fax:401-642-0911
Practice Address - Street 1:620 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4293
Practice Address - Country:US
Practice Address - Phone:401-642-0081
Practice Address - Fax:401-642-0911
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist