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General NPI Number Information
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NPI Number | 1437403672
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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 | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 4890 BARKSDALE BLVD
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City | BOSSIER CITY
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State | LA
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Zip | 71112-4566
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Country | US
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Telephone | 318-747-4330
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 CELEBRATION CV APT #706
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City | SHREVEPORT
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State | LA
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Zip | 71105-6201
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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 | PHARMACY SUPERVISOR
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Name | TARA DAVIS
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Credential |
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Telephone | 337-467-2048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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