Provider Demographics
NPI:1225428568
Name:CVS/PHARMACY
Entity Type:Organization
Organization Name:CVS/PHARMACY
Other - Org Name:1308
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DM
Authorized Official - Phone:700-600-1524
Mailing Address - Street 1:46 MIDDLEWAY PIKE
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3713
Mailing Address - Country:US
Mailing Address - Phone:304-229-4318
Mailing Address - Fax:304-229-1794
Practice Address - Street 1:46 MIDDLEWAY PIKE
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-3713
Practice Address - Country:US
Practice Address - Phone:304-229-4318
Practice Address - Fax:304-229-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center