Healthcare Provider Details

I. General information

NPI: 1609281492
Provider Name (Legal Business Name): CVS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4295 JEFFERSON DAVIS HWY
BEECH ISLAND SC
29842-4824
US

IV. Provider business mailing address

4295 JEFFERSON DAVIS HWY
BEECH ISLAND SC
29842-4824
US

V. Phone/Fax

Practice location:
  • Phone: 803-593-5196
  • Fax:
Mailing address:
  • Phone: 803-593-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number35543
License Number StateSC

VIII. Authorized Official

Name: DR. JOSHUA NATHANIEL NESBITT
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 706-836-5529