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General NPI Number Information
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NPI Number | 1235405523
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Entity Type | Organization
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Legal Business Name | CVS/PHARMACY
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 6050 SOUTH NORTH CAROLINA HIGHWAY 16
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City | DENVER
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State | NC
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Zip | 28037
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Country | US
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Telephone | 704-483-6759
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Fax | 704-483-6972
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Provider Business Mailing Address
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Address Line | 6050 SOUTH NORTH CAROLINA HWY 16
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City | DENVER
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State | NC
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Zip | 28037
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Country | US
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Telephone | 704-483-6759
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Fax |
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | MR. JOE CICCARELLO
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Credential |
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Telephone | 704-655-2730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17741
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License Number State | NC
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