Provider Demographics
NPI:1073085452
Name:CVS
Entity Type:Organization
Organization Name:CVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PHUONG-UYEN
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:619-206-4066
Mailing Address - Street 1:8355 STATION VILLAGE LN UNIT 4314
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6576
Mailing Address - Country:US
Mailing Address - Phone:161-920-6406
Mailing Address - Fax:
Practice Address - Street 1:9730 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3808
Practice Address - Country:US
Practice Address - Phone:619-448-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy