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
1	3336C0003X	Community/Retail Pharmacy	35583	SC

General Provider Information

NPI Number	:	1396149803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS/PHARMACY

Provider Business Mailing Address
First Line	:	4001 CORONADO DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-5409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 SAMS CROSSING RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-9591
Country	:	US
Telephone Number	:	803-788-0535
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DR. DAVID OUELLET
Credential	:	PHARMD
Telephone Number	:	803-479-8419

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	10/13/2014

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Directions to “CVS/PHARMACY ” Practice Location

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