Provider Demographics
NPI:1932647906
Name:HOLIDAY CVS LLC
Entity Type:Organization
Organization Name:HOLIDAY CVS LLC
Other - Org Name:NAVARRO DISCOUNT #10704
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CHIEF MERCHANT HISPANIC FORMAT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:URRUTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-665-3469
Mailing Address - Street 1:9675 NW 117TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1228
Mailing Address - Country:US
Mailing Address - Phone:407-582-0662
Mailing Address - Fax:
Practice Address - Street 1:12000 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1634
Practice Address - Country:US
Practice Address - Phone:786-353-0144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site