Provider Demographics
NPI:1093259160
Name:CVS
Entity Type:Organization
Organization Name:CVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-435-6433
Mailing Address - Street 1:4151 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2425
Mailing Address - Country:US
Mailing Address - Phone:520-452-7929
Mailing Address - Fax:520-226-3487
Practice Address - Street 1:4151 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2425
Practice Address - Country:US
Practice Address - Phone:520-452-7929
Practice Address - Fax:520-226-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0222773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy