Provider Demographics
NPI:1730775867
Name:RUCANDO, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:RUCANDO
Suffix:
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 1:77 BASIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-2801
Mailing Address - Country:US
Mailing Address - Phone:401-450-2972
Mailing Address - Fax:
Practice Address - Street 1:1360 W MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6301
Practice Address - Country:US
Practice Address - Phone:401-849-9640
Practice Address - Fax:401-849-0848
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist