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General NPI Number Information
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NPI Number | 1093104432
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Entity Type | Organization
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Legal Business Name | CVS HEALTH
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 201 GLEN ST
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City | GLEN COVE
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State | NY
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Zip | 11542-2734
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Country | US
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Telephone | 718-555-2424
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Fax | 516-525-1142
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Provider Business Mailing Address
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Address Line | 201 GLEN ST
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City | GLEN COVE
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State | NY
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Zip | 11542-2734
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Country | US
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Telephone | 914-759-5555
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Fax | 914-759-5556
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. NOHUM MANDIL
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Credential | PHARM.D
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Telephone | 914-268-1955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 059623
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 059623
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License Number State | NY
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