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General NPI Number Information
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NPI Number | 1255881074
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Entity Type | Organization
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Legal Business Name | CVS
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 1512 PROSPECT AVE APT D D
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City | SAN GABRIEL
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State | CA
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Zip | 91776-4422
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Country | US
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Telephone | 626-823-1189
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 PROSPECT AVE UNIT D
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City | SAN GABRIEL
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State | CA
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Zip | 91776-4422
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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 | PHARMACIST
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Name | GRACE LING SEK
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Credential | PHARM.D.
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Telephone | 626-823-1189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 75281
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License Number State | CA
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