Provider Demographics
NPI:1700200409
Name:CVS/CAREMARK
Entity Type:Organization
Organization Name:CVS/CAREMARK
Other - Org Name:CVS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGDIP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:JASPAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-289-9876
Mailing Address - Street 1:14354 W B ST
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1910
Mailing Address - Country:US
Mailing Address - Phone:559-289-9876
Mailing Address - Fax:559-800-7451
Practice Address - Street 1:14967 W WHITESBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1111
Practice Address - Country:US
Practice Address - Phone:559-842-0030
Practice Address - Fax:559-842-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-15
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55129OtherCALIFORNIA BOARD OF PHARMACY