Provider Demographics
NPI:1184030462
Name:CVS PHARMACY
Entity Type:Organization
Organization Name:CVS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VANTONILE
Authorized Official - Middle Name:VIEN
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:717-315-6103
Mailing Address - Street 1:1509 MAINLINE BLVD
Mailing Address - Street 2:APT 6202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-0518
Mailing Address - Country:US
Mailing Address - Phone:717-315-6103
Mailing Address - Fax:
Practice Address - Street 1:3310 SISKEY PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3222
Practice Address - Country:US
Practice Address - Phone:704-849-2271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty