| Name: | Suburban Pharmacy, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 19 Jun 1930 (95 years ago) |
| Identification Number: | 000044618 |
| ZIP code: | 02888 |
| County: | Kent County |
| Principal Address: | 242 PAWTUXET AVE, WARWICK, RI, 02888, USA |
| Purpose: | PHARMACY AND OTC, HBA, CONVENIENCE ITEMS |
| NAICS: | 446110 - Pharmacies and Drug Stores |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245373307 | 2007-02-15 | 2013-12-03 | 242 PAWTUXET AVE, WARWICK, RI, 028881933, US | 242 PAWTUXET AVE, WARWICK, RI, 028881933, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 401-781-2110 |
| Fax | 4017812640 |
Authorized person
| Name | NICHOLAS SHANOS |
| Role | OWNER AND PRESIDENT |
| Phone | 4017812110 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PHA00136 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2088084 |
| Issuer | MEDICAID |
| Number | SP00071 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| NICHOLAS SHANOS | Agent | 242 PAWTUXET AVENUE, WARWICK, RI, 02888, USA |
| Name | Role | Address |
|---|---|---|
| NICHOLAS SHANOS | TREASURER | 242 PAWTUXET AVENUE WARWICK, RI 02888 USA |
| Name | Role | Address |
|---|---|---|
| NICHOLAS SHANOS | SECRETARY | 242 PAWTUXET AVENUE WARWICK, RI 02888 USA |
| Name | Role | Address |
|---|---|---|
| NICHOLAS SHANOS | PRESIDENT | 242 PAWTUXET AVENUE WARWICK, RI 02888- USA |
| Name | Role | Address |
|---|---|---|
| NICHOLAS SHANOS | VICE PRESIDENT | 242 PAWTUXET AVENUE WARWICK, RI 02888 USA |
| Number | Name | File Date |
|---|---|---|
| 202448742120 | Annual Report | 2024-03-16 |
| 202329362720 | Annual Report | 2023-02-26 |
| 202212993060 | Annual Report | 2022-03-16 |
| 202187579430 | Annual Report | 2021-01-22 |
| 202037003120 | Annual Report | 2020-03-31 |
| 201988007540 | Annual Report | 2019-03-01 |
| 201861859260 | Annual Report | 2018-04-10 |
| 201739481300 | Annual Report | 2017-04-03 |
| 201692735430 | Annual Report | 2016-02-20 |
| 201553671820 | Annual Report | 2015-01-13 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
