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General NPI Number Information
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NPI Number | 1457727968
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Entity Type | Organization
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Legal Business Name | CVS CAREMARK
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 19100 MONTGOMERY VILLAGE AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20886-3701
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Country | US
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Telephone | 301-948-6886
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Fax |
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Provider Business Mailing Address
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Address Line | 19100 MONTGOMERY VILLAGE AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20886-3701
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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 | EVAN GOMBOS
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Credential | PHARMD
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Telephone | 301-968-6886
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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 | 23035
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License Number State | MD
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