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General NPI Number Information
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NPI Number | 1386199479
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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 | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 3126 DALLAS HIGH SHOALS HWY
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City | DALLAS
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State | NC
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Zip | 28034-1306
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Country | US
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Telephone | 704-922-5257
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Fax |
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Provider Business Mailing Address
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Address Line | 102 FEIMSTER ST
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City | STATESVILLE
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State | NC
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Zip | 28677-5204
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Country | US
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Telephone | 704-450-5352
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | NISHMA PATEL
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Credential |
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Telephone | 704-450-5352
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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 | 26249
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License Number State | NC
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