Provider Demographics
NPI:1184041154
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:ANGELA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:FLORES GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:928-442-0312
Mailing Address - Street 1:506 MILLER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2314
Mailing Address - Country:US
Mailing Address - Phone:928-442-0312
Mailing Address - Fax:928-442-0321
Practice Address - Street 1:506 MILLER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2314
Practice Address - Country:US
Practice Address - Phone:928-442-0312
Practice Address - Fax:928-442-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0121753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS012175OtherPHARMACIST