Provider Demographics
NPI:1255745816
Name:CVS 3967
Entity type:Organization
Organization Name:CVS 3967
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SROKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-786-3478
Mailing Address - Street 1:3990 W RAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2478
Mailing Address - Country:US
Mailing Address - Phone:480-786-3478
Mailing Address - Fax:480-786-3922
Practice Address - Street 1:3990 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2478
Practice Address - Country:US
Practice Address - Phone:480-786-3478
Practice Address - Fax:480-786-3922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CVS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy