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	251X00000X	Supports Brokerage Agency	012550	AZ

General Provider Information

NPI Number	:	1598183741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS PHARMACY

Provider Business Mailing Address
First Line	:	7026 E ROLAND ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-1280
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 N POWER RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1728
Country	:	US
Telephone Number	:	480-396-8301
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	LIANE FOSSEN
Credential	:
Telephone Number	:	480-219-4199

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	04/04/2014

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Directions to “CVS PHARMACY ” Practice Location

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