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General NPI Number Information
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NPI Number | 1215481460
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Entity Type | Organization
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Legal Business Name | CVS CAREMARK
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 404 RAMSEY ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4910
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Country | US
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Telephone | 910-484-1106
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Fax |
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Provider Business Mailing Address
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Address Line | 404 RAMSEY ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY SUPERVISOR
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Name | DUSTIN EDGE
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Credential |
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Telephone | 910-424-0317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 24653
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License Number State | NC
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