Provider Demographics
NPI:1790239861
Name:CVS HEALTH
Entity Type:Organization
Organization Name:CVS HEALTH
Other - Org Name:LONGS DRUGS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:NGO
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:808-557-9034
Mailing Address - Street 1:91-1031 KAIMALIE ST APT 4S3
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6017
Mailing Address - Country:US
Mailing Address - Phone:808-557-9034
Mailing Address - Fax:
Practice Address - Street 1:91-919 FORT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2257
Practice Address - Country:US
Practice Address - Phone:808-689-5860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIT130529005OtherHAWAII PHARMACY INTERN LICENSE