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General NPI Number Information
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NPI Number | 1417375965
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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 | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 5954 E MCDOWELL RD
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City | MESA
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State | AZ
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Zip | 85215-9607
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Country | US
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Telephone | 480-830-4518
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Fax | 480-830-4980
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Provider Business Mailing Address
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Address Line | 5954 E MCDOWELL RD
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City | MESA
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State | AZ
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Zip | 85215-9607
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Country | US
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Telephone | 480-830-4518
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Fax | 480-830-4980
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Authorized Official
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Title or Position | PHARMACIST
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Name | JAMES HUBER
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Credential | R.PH.
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Telephone | 480-830-4518
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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 | S08336
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License Number State | AZ
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