Provider Demographics
NPI:1962830091
Name:CVS
Entity Type:Organization
Organization Name:CVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:ANDRIA
Authorized Official - Last Name:OATS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-598-8119
Mailing Address - Street 1:3001 E TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3207
Mailing Address - Country:US
Mailing Address - Phone:318-742-6600
Mailing Address - Fax:318-742-7207
Practice Address - Street 1:3001 E TEXAS ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3207
Practice Address - Country:US
Practice Address - Phone:318-742-6600
Practice Address - Fax:318-742-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMS.0023023336C0003X
LAMA.0023023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy