=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063947570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CVS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2017
-----------------------------------------------------
Last Update Date | 04/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2609 IVY DR APT 16
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94606-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-256-8510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2609 IVY DR APT 16
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94606-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-256-8510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | EDWINA YIN CHING LEUNG
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 808-256-8510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 74633
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 74633
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------