Healthcare Provider Details

I. General information

NPI: 1699098889
Provider Name (Legal Business Name): CVS CAREMARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 CARMAN RD 3916 CARMAN ROAD
SCHENECTADY NY
12303-5608
US

IV. Provider business mailing address

3916 CARMAN RD 3916 CARMAN ROAD
SCHENECTADY NY
12303-5608
US

V. Phone/Fax

Practice location:
  • Phone: 518-357-0061
  • Fax: 518-357-0767
Mailing address:
  • Phone: 518-357-0061
  • Fax: 518-357-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number030927
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01472893
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MS. JOANNE MCTAGUE
Title or Position: STAFF PHARMACIST
Credential: REGISTERED PHARMACIS
Phone: 518-357-0061