Provider Demographics
NPI:1184062879
Name:CVS MINUTE CLINIC
Entity type:Organization
Organization Name:CVS MINUTE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:740-225-3183
Mailing Address - Street 1:969 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1070
Mailing Address - Country:US
Mailing Address - Phone:937-644-3615
Mailing Address - Fax:
Practice Address - Street 1:969 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1070
Practice Address - Country:US
Practice Address - Phone:937-644-3615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363LF0000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center