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General NPI Number Information
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NPI Number | 1578003224
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Entity Type | Organization
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Legal Business Name | CVS HEALTH
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 5200 YORK RD
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City | BALTIMORE
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State | MD
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Zip | 21212-4215
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Country | US
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Telephone | 410-433-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 9714 BRITINAY LN 9174 BRITINAY LANE
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City | PARKVILLE
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State | MD
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Zip | 21234-1862
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Country | US
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Telephone | 410-433-7711
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Fax | 410-433-2919
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. JUDY JINA SIM
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Credential | PHARM.D.
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Telephone | 410-433-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 24468
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License Number State | MD
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