Provider Demographics
NPI: | 1720406978 |
---|---|
Name: | CVS PHARMACY |
Entity Type: | Organization |
Organization Name: | CVS PHARMACY |
Other - Org Name: | CVS PHARMACY |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | STAFF PHARMACIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KINJAL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHAH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHARMD |
Authorized Official - Phone: | 623-217-6086 |
Mailing Address - Street 1: | 9172 W UNION HILLS DR |
Mailing Address - Street 2: | |
Mailing Address - City: | PEORIA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85382-8177 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 623-572-0054 |
Mailing Address - Fax: | 623-572-9506 |
Practice Address - Street 1: | 9172 W UNION HILLS DR |
Practice Address - Street 2: | |
Practice Address - City: | PEORIA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85382-8177 |
Practice Address - Country: | US |
Practice Address - Phone: | 623-572-0054 |
Practice Address - Fax: | 623-572-9506 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-04-04 |
Last Update Date: | 2014-04-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 183500000X | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |