Healthcare Provider Details

I. General information

NPI: 1528453032
Provider Name (Legal Business Name): CVS PHARMACY, ALBANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 CHRISLER AVE
SCHENECTADY NY
12303-1829
US

IV. Provider business mailing address

1052 EASTERN AVE
SCHENECTADY NY
12308-3441
US

V. Phone/Fax

Practice location:
  • Phone: 518-382-5391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number058209
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier00862886
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: PAIGE A WELLS
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 518-275-3926