=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538041892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CV PHARMACY HOLDING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2025
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 W 35TH ST STE 104A
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-7926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-271-2162
-----------------------------------------------------
Fax | 855-609-7570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 W 35TH ST STE 104A
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-7926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-271-2162
-----------------------------------------------------
Fax | 855-609-7570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELVIS ATENCIO
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 619-507-3969
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------