Healthcare Provider Details

I. General information

NPI: 1831478551
Provider Name (Legal Business Name): CVS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13461 NC HIGHWAY 50
SURF CITY NC
28445-6553
US

IV. Provider business mailing address

13461 NC HIGHWAY 50
SURF CITY NC
28445-6553
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-0484
  • Fax: 910-329-0489
Mailing address:
  • Phone: 910-329-0484
  • Fax: 910-329-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19871
License Number StateNC

VIII. Authorized Official

Name: DR. LARISSA GEM TAYLOR
Title or Position: STAFF PHARMACIST
Credential: RPH
Phone: 910-329-0484