MEDICARE: CVS/PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S018742	AZ

General Provider Information

NPI Number	:	1356769053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS/PHARMACY

Provider Business Mailing Address
First Line	:	9069 W LAKE PLEASANT PKWY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8361
Country	:	US
Telephone Number	:	623-376-0549
Fax Number	:	623-362-3431

Provider Business Practice Location Address
First Line	:	9069 W LAKE PLEASANT PKWY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8361
Country	:	US
Telephone Number	:	623-376-0549
Fax Number	:	623-362-3431

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MRS. SHELLEY MARIE MEYER
Credential	:	PHARM.D.
Telephone Number	:	623-376-0549

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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