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General NPI Number Information
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NPI Number | 1407265887
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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 | 08/10/2014
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Last Update Date | 08/10/2014
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Provider Practice Location Address
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Address Line | 15010 N 59TH AVE APT 251
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City | GLENDALE
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State | AZ
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Zip | 85306-3255
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Country | US
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Telephone | 617-686-3072
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Fax |
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Provider Business Mailing Address
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Address Line | 15010 N 59TH AVE APT 251
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City | GLENDALE
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State | AZ
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Zip | 85306-3255
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Country | US
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Telephone | 617-686-3072
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | BOULES ZAGHLOL TAKLA
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Credential |
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Telephone | 617-686-3072
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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 | S017305
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License Number State | AZ
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