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General NPI Number Information
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NPI Number | 1801246251
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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 | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 13740 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32224-6033
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Country | US
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Telephone | 904-248-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 13740 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32224-6033
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Country | US
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Telephone | 904-248-4364
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MARY ALICE ANDERSON
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Credential | PHARMD
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Telephone | 904-412-6410
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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 | PS54875
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License Number State | FL
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