Provider Demographics
NPI:1447797063
Name:CMVO, LLC
Entity Type:Organization
Organization Name:CMVO, LLC
Other - Org Name:CROSSROADS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:VANORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-839-7000
Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-1539
Mailing Address - Country:US
Mailing Address - Phone:706-839-7000
Mailing Address - Fax:706-839-7001
Practice Address - Street 1:4654 HIGHWAY 115
Practice Address - Street 2:UNIT 1
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-839-7000
Practice Address - Fax:706-839-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0103323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy