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General NPI Number Information
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NPI Number | 1093135691
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Entity Type | Organization
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Legal Business Name | CVS/PHARMACY #9293
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 325 W APACHE TRL
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-3954
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Country | US
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Telephone | 480-973-1129
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Fax | 480-983-1547
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Provider Business Mailing Address
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Address Line | 1848 S POWER RD APT 2323
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City | MESS
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State | AZ
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Zip | 85206
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Country | US
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Telephone | 270-480-3066
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Fax |
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | MR. DAVID CRENSHAW SMITH
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Credential | R.PH.
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Telephone | 480-983-1129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | S019677
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License Number State | AZ
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