Provider Demographics
NPI:1245764125
Name:CVS
Entity Type:Organization
Organization Name:CVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABAYOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEWODU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:757-667-0038
Mailing Address - Street 1:2430 NORTHWICK DR
Mailing Address - Street 2:APT. 202
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6497
Mailing Address - Country:US
Mailing Address - Phone:757-667-0038
Mailing Address - Fax:
Practice Address - Street 1:1119 EASTCHESTER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3113
Practice Address - Country:US
Practice Address - Phone:336-881-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty