Provider Demographics
NPI:1366487266
Name:GARFIELD BEACH CVS LLC
Entity Type:Organization
Organization Name:GARFIELD BEACH CVS LLC
Other - Org Name:CVS PHARMACY 09479
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER PHARMACY ENROLLMENTS
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2937
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:PO BOX 1075
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-765-1550
Mailing Address - Fax:
Practice Address - Street 1:2510 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1273
Practice Address - Country:US
Practice Address - Phone:760-729-8941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5620984OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5620984OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5541620256Medicare NSC