Provider Demographics
NPI:1912315318
Name:CVS/PHARMACY
Entity Type:Organization
Organization Name:CVS/PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONSZEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-230-9898
Mailing Address - Street 1:11416 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3082
Mailing Address - Country:US
Mailing Address - Phone:301-230-9898
Mailing Address - Fax:301-984-1604
Practice Address - Street 1:11416 ROCKVILLE PIKE
Practice Address - Street 2:SUITE D
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3082
Practice Address - Country:US
Practice Address - Phone:301-230-9898
Practice Address - Fax:301-984-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD661109500Medicaid