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General NPI Number Information
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NPI Number | 1659777563
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Entity Type | Organization
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Legal Business Name | CVS CAREMARK MINUTECLINIC
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 1279 W MAIN ST ROBINWOOD SHOPPING PLAZA
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City | WATERBURY
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State | CT
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Zip | 06708-3101
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Country | US
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Telephone | 860-922-2435
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Fax |
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Provider Business Mailing Address
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Address Line | 52 KAYTONNE AVE
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City | WATERBURY
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State | CT
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Zip | 06710-1742
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Country | US
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Telephone | 860-922-2435
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. CARMEN IVETTE MARTELL
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Credential | APRN
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Telephone | 860-922-2435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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