| Name: | CCR PHARMACY, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 06 Sep 2007 (17 years ago) |
| Identification Number: | 000221299 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 1165 MAIN AVENUE, WARWICK, RI, 02886, USA |
| Mailing Address: | 50 PARK ROW WEST SUITE 107, PROVIDENCE, RI, 02903, USA |
| Purpose: | TO ACT AS A PHARMACY |
| NAICS: | 446110 - Pharmacies and Drug Stores |
| Fictitious names: |
J.B. Pharmacy II, LLC (trading name, 2007-09-06 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609306919 | 2017-06-19 | 2021-03-24 | 1017 SMITH ST, PROVIDENCE, RI, 02908, US | 1017 SMITH ST, PROVIDENCE, RI, 029082747, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-861-1194 |
| Fax | 4013837773 |
Authorized person
| Name | PAUL CAPUANO |
| Role | PHARMACIST/OWNER |
| Phone | 4018611194 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PHA00542 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | JP68164 |
| State | RI |
| Issuer | PK |
| Number | 2169883 |
| Name | Role | Address |
|---|---|---|
| STEPHEN J. DIGIANFILIPPO, ESQ. | Agent | VIEIRA & DIGIANFILIPPO LTD. 50 PARK ROW WEST, PROVIDENCE, RI, 02903, USA |
| Number | Name | File Date |
|---|---|---|
| 202452113310 | Annual Report | 2024-04-22 |
| 202452113040 | Statement of Change of Registered/Resident Agent Office | 2024-04-22 |
| 202329390660 | Annual Report | 2023-02-24 |
| 202213642570 | Annual Report | 2022-03-24 |
| 202103832470 | Annual Report | 2021-10-22 |
| 202065351990 | Annual Report | 2020-10-13 |
| 201930459630 | Annual Report - Amended | 2019-12-19 |
| 201926681100 | Annual Report | 2019-10-30 |
| 201879743900 | Annual Report | 2018-10-18 |
| 201751441630 | Annual Report | 2017-10-11 |
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
