Provider Demographics
NPI:1134724669
Name:OVERTON, CAROLYN (RPH)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CVS PHARMACY
Mailing Address - Street 2:24 GATEWAY LANE
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927
Mailing Address - Country:US
Mailing Address - Phone:434-374-8728
Mailing Address - Fax:434-374-4251
Practice Address - Street 1:CVS PHARMACY
Practice Address - Street 2:24 GATEWAY LANE
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927
Practice Address - Country:US
Practice Address - Phone:434-374-8728
Practice Address - Fax:434-374-4251
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty