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General NPI Number Information
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NPI Number | 1780058073
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Entity Type | Organization
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Legal Business Name | CVS PHARMACY 7079
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Dates
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Enumeration Date | 11/24/2015
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 2200 N HARBOR BLVD
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City | FULLERTON
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State | CA
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Zip | 92835-2605
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Country | US
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Telephone | 714-269-6871
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 CALLE ALEGRIA
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City | FULLERTON
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State | CA
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Zip | 92833-1747
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Country | US
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Telephone | 714-269-6871
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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 | DEAN PAK
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Credential | PHARMD
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Telephone | 714-269-6871
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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 | 71851
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License Number State | CA
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