MEDICARE: CVS

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	305R00000X	Preferred Provider Organization	034318	NY

General Provider Information

NPI Number	:	1962689604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS

Provider Business Mailing Address
First Line	:	682 ROUTE 25A
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-1238
Country	:	US
Telephone Number	:	631-246-8735
Fax Number	:

Provider Business Practice Location Address
First Line	:	682 ROUTE 25A
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-1238
Country	:	US
Telephone Number	:	631-246-8735
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	MR. JEROME M WEXLER
Credential	:
Telephone Number	:	631-246-8735

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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Directions to “CVS ” Practice Location

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