Provider Demographics
NPI:1437514072
Name:CVS HEALTH
Entity Type:Organization
Organization Name:CVS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THERIAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-541-2700
Mailing Address - Street 1:3611 BLADENSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1809
Mailing Address - Country:US
Mailing Address - Phone:301-227-6667
Mailing Address - Fax:301-277-1897
Practice Address - Street 1:3611 BLADENSBURG RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-1809
Practice Address - Country:US
Practice Address - Phone:301-227-6667
Practice Address - Fax:301-277-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD236663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD332507500Medicaid