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General NPI Number Information
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NPI Number | 1457752131
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Entity Type | Organization
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Legal Business Name | CVS
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 4240 S MAIN ST
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City | FARMVILLE
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State | NC
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Zip | 27828-9539
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Country | US
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Telephone | 252-753-2061
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 TUSCANY DR
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City | GREENVILLE
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State | NC
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Zip | 27858-9146
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Country | US
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Telephone | 336-470-3065
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Fax |
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | MR. SCOTT CHRISTOPHER TROUTMAN
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Credential | PHARM.D.
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Telephone | 336-470-3065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 20534
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License Number State | NC
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