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General NPI Number Information
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NPI Number | 1457895872
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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 | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 6360 W 3RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90036-3155
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Country | US
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Telephone | 323-937-3019
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Fax |
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Provider Business Mailing Address
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Address Line | 6360 W 3RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90036-3155
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Country | US
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Telephone | 323-937-3019
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. KWAKU Y AGYEMAN
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Credential | PHARMD
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Telephone | 909-255-6584
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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 | RPH 71925
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License Number State | CA
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