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NPI Code Detail

MEDICARE: CVS PHARMACY

MEDICARE: CVS PHARMACY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302R00000XHealth Maintenance Organization

General Provider Information

NPI Number : 1063715480
Entity Type Code : Organization
Provider Name (Legal Business Name) : CVS PHARMACY
Provider Business Mailing Address
First Line : 3919 MOUNTAIN DR
Second Line :
City : MONROE
State : NC
Zip : 28112-8147
Country : US
Telephone Number : 704-242-0838
Fax Number :
Provider Business Practice Location Address
First Line : 2501 W ROOSEVELT BLVD
Second Line :
City : MONROE
State : NC
Zip : 28110-0418
Country : US
Telephone Number : 704-283-1506
Fax Number :
Authorized Official
Title or Position : PHARMD RPH
Name : DR. ADRIANE WALDRON
Credential :
Telephone Number : 704-289-2034
Provider Enumeration Date : 12/07/2010
Last Update Date : 12/07/2010

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Directions to “CVS PHARMACY ” Practice Location

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