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General NPI Number Information
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NPI Number | 1659654200
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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 | 09/20/2011
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 2771 W 5TH ST
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City | LUMBERTON
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State | NC
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Zip | 28358-7819
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Country | US
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Telephone | 910-739-8144
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Fax |
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Provider Business Mailing Address
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Address Line | 2771 W 5TH ST
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City | LUMBERTON
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State | NC
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Zip | 28358-7819
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | KENNETH NORMAN TATUM SR.
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Credential |
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Telephone | 910-739-8144
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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 | 8804
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License Number State | NC
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