Provider Demographics
NPI:1629502109
Name:CVS PHARMACY
Entity Type:Organization
Organization Name:CVS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:BAUCOM
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-855-1942
Mailing Address - Street 1:1606 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3704
Mailing Address - Country:US
Mailing Address - Phone:336-855-1942
Mailing Address - Fax:
Practice Address - Street 1:1606 FOX HOLLOW RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3704
Practice Address - Country:US
Practice Address - Phone:336-855-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CVS RX SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy