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NPI Code Detail

MEDICARE: GARFIELD BEACH CVS LLC

MEDICARE: GARFIELD BEACH CVS LLC
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
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15620201OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1114963279
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARFIELD BEACH CVS LLC
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : PO BOX 1075
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1020 IRVINE AVE
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-4602
Country : US
Telephone Number : 949-642-0122
Fax Number :
Authorized Official
Title or Position : MANAGER PHARMACY ENROLLMENTS
Name : CRISTIANA MAURICIO
Credential :
Telephone Number : 401-770-2937
Provider Enumeration Date : 06/20/2006
Last Update Date : 11/19/2009

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