Provider Demographics
NPI:1669720215
Name:CVS PHARMACY
Entity type:Organization
Organization Name:CVS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BROWNLEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-216-7021
Mailing Address - Street 1:2884 N HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8915
Mailing Address - Country:US
Mailing Address - Phone:843-216-7028
Mailing Address - Fax:
Practice Address - Street 1:2884 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8915
Practice Address - Country:US
Practice Address - Phone:843-216-7028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC203649684302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization