Provider Demographics
NPI:1821603994
Name:ARIZONA CVS STORES
Entity Type:Organization
Organization Name:ARIZONA CVS STORES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DUAA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-331-0309
Mailing Address - Street 1:75 LAKE HAVASU AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5651
Mailing Address - Country:US
Mailing Address - Phone:928-854-6300
Mailing Address - Fax:
Practice Address - Street 1:75 LAKE HAVASU AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5651
Practice Address - Country:US
Practice Address - Phone:928-854-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA CVS STORES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-15
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy