Provider Demographics
NPI:1356769053
Name:CVS/PHARMACY
Entity type:Organization
Organization Name:CVS/PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:623-376-0549
Mailing Address - Street 1:9069 W LAKE PLEASANT PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8361
Mailing Address - Country:US
Mailing Address - Phone:623-376-0549
Mailing Address - Fax:623-362-3431
Practice Address - Street 1:9069 W LAKE PLEASANT PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8361
Practice Address - Country:US
Practice Address - Phone:623-376-0549
Practice Address - Fax:623-362-3431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CVSCAREMARK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty