Provider Demographics
NPI:1093135691
Name:CVS/PHARMACY #9293
Entity Type:Organization
Organization Name:CVS/PHARMACY #9293
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CRENSHAW
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:480-983-1129
Mailing Address - Street 1:1848 S POWER RD
Mailing Address - Street 2:APT 2323
Mailing Address - City:MESS
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:270-480-3066
Mailing Address - Fax:
Practice Address - Street 1:325 W APACHE TRL
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3954
Practice Address - Country:US
Practice Address - Phone:480-973-1129
Practice Address - Fax:480-983-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0196773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy