Provider Demographics
NPI:1639492598
Name:CVS/PHARMACY
Entity Type:Organization
Organization Name:CVS/PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:866-222-9438
Mailing Address - Street 1:2 WEST RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7904
Mailing Address - Country:US
Mailing Address - Phone:845-635-1350
Mailing Address - Fax:845-635-9366
Practice Address - Street 1:2 WEST RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7904
Practice Address - Country:US
Practice Address - Phone:845-635-1350
Practice Address - Fax:845-635-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040238333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy