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General NPI Number Information
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NPI Number | 1629529912
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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 | 10/21/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 7525 EADS AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-4806
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Country | US
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Telephone | 858-273-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 7525 EADS AVE
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City | LA JOLLA
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State | SAN DIEGO
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Zip | 92037
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Country | UM
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Telephone | 858-551-0699
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MRS. FARAH RIYADH KORMANGY
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Credential | RPH
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Telephone | 619-729-2484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 74338
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License Number State | CA
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