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General NPI Number Information
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NPI Number | 1730562695
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Entity Type | Organization
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Legal Business Name | CVS
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 4755 W. ROSECRANS AVE
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City | HAWTHORNE
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State | CA
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Zip | 90505-5525
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Country | US
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Telephone | 310-263-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 4755 W. ROSECRANS AVE
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City | HAWTHORNE
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State | CA
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Zip | 90505-5525
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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 | STAFF PHARMACIST
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Name | VAN DO
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Credential |
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Telephone | 310-408-2627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 65074
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License Number State | CA
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