Provider Demographics
NPI:1720407703
Name:CVS PHARMACY INC. AGENT FOR CVS RX SERVICES, INC.
Entity Type:Organization
Organization Name:CVS PHARMACY INC. AGENT FOR CVS RX SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:HANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-444-3152
Mailing Address - Street 1:7530 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5202
Mailing Address - Country:US
Mailing Address - Phone:623-334-4635
Mailing Address - Fax:
Practice Address - Street 1:7530 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5202
Practice Address - Country:US
Practice Address - Phone:623-334-4635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty